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Full text of "U.S. Navy Medicine Vol. 69, No. 11 November 1978"

VADM Wlilard P. Arentzen, MC, USN 

Surgeon General of the Navy 

RADM H.A. Sparks, MC, USN 

Deputy Surgeon General 

Director of Public Affairs 

ENS Richard A. Schmidt, USNR 

Managing Editor 

Ellen Casselberry 

Assistant Editor 
Virginia M. Novinski 

Editorial Assistant 

Nancy R. Keesee 



Contributing Editors 

Contributing Editor-in-Chief: CDR E.L. 
Taylor (MC); Aerospace Medicine: 
CAPT M.G. Webb (MC); Dental Corps: 
CAPT R.D. Ulrey (DC); Education: LT 
R.E. Bubb (MSC); Fleet Support: LCDR 
J.D. Schweitzer (MSC); Gastroenterol- 
ogy: CAPT D.O. Castell (MC); Hospital 
Corps: HMCM H.A. Olszak; Legal: 
LCDR R.E. Broach (JAGC); Marine 
Corps: CAPT D.R. Hauler (MC); Medi- 
cal Service Corps: CAPT P.D. Nelson 
(MSC); Nephrology: CDR J.D. Wallin 
(MC); Nurse Corps: CAPT P.J, Elsass 
(NC); Occupational Medicine: CDR J.J. 
Bellanca (MC); Preventive Medicine: 
CAPT D.F. Hoeffler (MC); Research: 
CAPT J. P. Bloom (MC); Submarine 
Medicine: CAPT J.C. Rivera (MC) 



POLICY: U.S. Navy Medicine is In official publication 
of the Navy Medical Department, published by the Bureau 
of Medicine and Surgery. It disseminates to Navy Medical 
Department personnel official and professional information 
relative Co medicine, dentistry, and the allied health sci- 
ences. Opinions expressed are those of the authors and do 
not necessarily represent the official position of the Depart- 
ment of the Navy, the Bureau of Medicine and Surgery, or 
any other governmental department or agency. Trade 
names are used for identification only and do not represent 
an endorsement by the Department of the Navy or the Bu- 
reau of Medicine and Surgery. Although U.S. Navy Medi- 
cine may cite or extract From directives, official authority for 
action should be obtained from the cited reference. 

DISTRIBUTION: U.S. Navy Medicine a distributed to 
active-duty Medical Department personnet via the Standard 
Navy Distribution List. The following distribution is author- 
ized: one copy for each Medical, Dental, Medical Service 
and Nurse Corps officer; one copy for every 10 enlisted 
Medical Department members. Requests to increase or de- 
crease the number of allotted copies should be forwarded to 
U. S. Navy Medicine via the local command. 

CORRESPONDENCE: All correspondence should be 
addressed to: Editor. U.S. Navy Medicine. Department of 
the Navy. Bureau of Medicine and Surgery (Code 0010), 
Washington, D.C 20372. Telephone: (Area Code 202) 254- 
4253. 254-4316, 254-4214; Autovon 294-4253. 294-4316, 294- 
4214. Contributions from the field are welcome and will be 
published as space permits, subject to editing and possible 
abridgment. 

The issuance of this publication is approved in accordance 
with Department of the Navy Publications and Printing 
Regulations (NAVEXOS P-35>. 



U.S.NAVY 




Vol. 69, No. 11 
November 1978 



1 From the Surgeon General 

2 Department Rounds 

New Hospital Corps Division Director Named . . . Dr. Kaires Gets 
Her Dolphins 

4 Notes and Announcements 

6 Special Report 

The Surgeon General's 10th Annual Specialties Advisory Confer- 
ence and Committees' Meeting — First Plenary Session 
6 Surgeon General's Keynote Address 

VADM W.P. Arentzen, MC, USN 
9 OP-093: A Status Report 

CAPT EM. Bryant, MSC, USN 
12 Contingency Planning 

CAPT J.J. Quinn, MC, USN 
14 Medical Readiness for Operational Contingencies 

RADM H.A. Sparks, MC, USN 
17 Medical Department Personnel: Issues and Initiatives 

RADM R.F. Milnes, MC, USN 
19 Medical Corps Manpower 

CAPT J. E. Can, MC, USN 
25 Budget Update: Dollars, Facilities, Equipment 

RADM A. C. Wilson, MC, USN 

28 Scholars' Scuttlebutt 

Your Reimbursements: Speeding the Process 

29 BUMED SITREP 



COVER: Behind this 290-pound rig is LCDR Pamela A. Kaires (MC), 
the Navy's first woman to dive to depths of 300 feet — and the first 
ever to qualify as a submarine medical officer (see page 3). Photo by 
PH2 Jim Preston. 



NAVMED P-5088 



From the Surgeon General 



The Unsung 
Specialists 



Various specialists on our Medi- 
cal Department team are highly 
lauded from time to time. General- 
ly, attention is drawn to individuals 
operating in a primarily clinical 
mode. But when the overall Navy 
mission is examined, we must rec- 
ognize that we have unsung spe- 
cialists among us: those engaged in 
operational medicine. 

The readiness and proper func- 
tioning of the forces afloat is the 
"name of the game." But the oper- 
ational medicine specialist stands in 
the front line. He or she is unique 
and has no precise parallel in the ci- 
vilian community. Needless to say, 
the flight surgeons and undersea 
physicians are in the vanguard — but 
so, too, are the aviation and diving 
physiologists, and the aerospace 
and submarine medical technicians, 
both officer and enlisted, who back 
up those physicians, and without 
whom those physicians could not 
function. 

I salute all of you and wish to 
make known to you publicly that we 




recognize and appreciate your tal- 
ents and dedication. 

I am taking a personal interest in 
programs designed to augment the 
attractiveness of your career pat- 
terns and your professional pro- 
gress. I feel strongly that you are an 
integral part of the medical team. 

Those of us who are not primarily 
in operational medicine might well 
consider not only the contribution to 
be made, but the rewards to be har- 
vested, by joining your ranks. 

And we should see to it that 
operational medicine is no longer 
the repository of the unsung. 




W.P. ARENTZEN 

Vice Admiral, Medical Corps 

United States Navy 



Volume 69, November 1978 



Department Rounds 



New Hospital Corps Division Director Named 



CAPT Roy W. Tandy (MSC) has 
been named director of the Navy 
Medical Department's Hospital 
Corps Division. He reported on 
board at BUMED in late July, after 
last serving as director of adminis- 
trative services at NRMC Great 
Lakes. 

CAPT Tandy entered the Navy as 
a seaman recruit in 1951 and was 
commissioned an ensign in 1957. 
His naval service includes assign- 
ments aboard the USS Staten Is- 
land, an icebreaker in the Arctic; as 
an independent duty corpsman 
aboard the minesweeper USS For- 
tify; as a data-processing officer at 
Bethesda and San Diego; and as 
administrative/supply officer in 
Okinawa with the Marines during 
the Vietnam conflict. More recently, 
he established the naval medical 
region in Hawaii and served as its 
first executive officer before his ap- 
pointment as DAS at Great Lakes. 

"The Hospital Corps is relatively 
healthy and becoming more so each 
day," says CAPT Tandy. "There 
are, right now, 23,271 Hospital 
Corps billets around the world, 
filled by 22,026 corpsmen. If we can 
fill the school seats that we have, we 
should reach 100% in the next fiscal 
year." 

The Hospital Corps has taken a 
number of new initiatives with re- 
spect to training, including develop- 
ment of a respiratory care techni- 
cian package that will provide seats 
for selected corpsmen in the Army 
School at Fort Sam Houston, begin- 
ning next year. 

Another area under study is 
management training for the E-8 
and E-9 communities. "There has 
been no formal training in manage- 
ment for these people, nor have 



there been openings in middle- 
management positions," CAPT 
Tandy says. "One of the initiatives 
of the Surgeon General is to bring 
the E-8 and E-9 into middle-man- 
agement positions at our medical 
facilities." 




In the Hospital Corps, as else- 
where in the Navy, much planning 
is being devoted to making full use 
of the talents of women — and to 
preparing for their service aboard 
Navy ships and in other "new" as- 
signments. 

"Young women in the Hospital 
Corps are beginning to enter fields 
that have been traditionally male, 



such as medical repair," says CAPT 
Tandy. "I'm very pleased with that 
and want to encourage it. We're in- 
creasing the basic ratio of females 
to males." 

As to problems for the Hospital 
Corps, the biggest one just now, he 
says, is "getting students into the 
schools. If we don't have enough 
qualified volunteers, we can't bring 
our technical specialties up to 
strength. In the most recent selec- 
tions, we were able to fill most of 
the school seats with reasonably 
well-qualified people, but pharmacy 
and submarine medicine are des- 
perately short of volunteers." (A 
recent increase in bonus pay for 
submariners should help that cate- 
gory, he notes.) 

The retention rate for hospital 
corpsmen at the first-term decision 
point is currently 22.1% — much 
better than that of the recent past — 
but there's room for further im- 
provement, says CAPT Tandy. "We 
need to offer these people career 
patterns that meet their needs. We 
recognize the need, and we're 
working on it." 

Of his new job, he says: "I'm 
pleased and to some extent flattered 
to be here. I'm also somewhat 
amazed by my misconceptions of 
the Bureau — and I suspect the mis- 
conceptions of many field officers — 
as to its omnipotence. We are not a 
Navy unto ourselves, but part of the 
U.S. Navy, and I'm convinced that 
awareness may be more acute here 
than in the field. 

"There seems to be a tendency in 
the field to think that BUMED is all- 
powerful. But we vie for the same 
assets as the rest of the Navy. 
There's no cornucopia of dollars and 
people here at the Bureau." 



U.S. Navy Medicine 



Dr. Kaires Gets Her Dolphins 



At the Naval Undersea Medical 
Institute, Groton, Conn., LCDR 
Pamela A. Kaires (MC) recently 
became the first woman ever to re- 
ceive the twin dolphin pin that sig- 
nifies qualification as a submarine 
medical officer. 

The award ceremony, held in late 
September, marked LCDR Kaires' 
successful completion of a rigorous 
six-month course in submarine 
medicine, covering biomedical dis- 
ciplines as applied to the submarine 
and diving environment. 



The course included eight weeks 
of instruction at the Navy School of 
Diving and Salvage, in Washington, 
D.C., during which Dr. Kaires be- 
came the Navy's first woman to dive 
to depths of 300 feet, using the 290- 
pound Mark V mixed-gas diving 
outfit. 

Dr. Kaires, a graduate of The 
George Washington University 
Medical School in the nation's capi- 
tal, completed her internship and 
her residency in internal medicine 
at NRMC San Diego, She came by 



For Dr. Kaires, diving school was one step along the rigorous way to her dolphins. 



her interest in Navy medicine natu- 
rally, since her father — RADM 
Anthony K. Kaires — is a retired 
Navy dentist and her sister — LT 
Cynthia Kaires — is a Navy nurse. 

Next month, Dr. Kaires will leave 
New London for a new assignment 
at the Naval Regional Medical 
Clinic, Hawaii, with additional duty 
to Submarine Squadron Seven at 
Pearl Harbor. Though current law 
prohibits her from actually serving 
aboard a submarine, she sees many 
possibilities ahead for challenging 
work in her chosen specialty, and 
looks forward particularly to in- 
volvement in hyperbaric research. 



Photo bv PH2 Jim Preston 




Volume 69, November 1978 



Notes & Announcements 



In memoriam . . . RADM Alfred W. Chandler, DC, USN 
(Ret.), former assistant chief of the Bureau of Medicine 
and Surgery for Dentistry and chief of the Dental Divi- 
sion, died 24 Sept 1978, at age 88. 

RADM Chandler was born in Newport, R.I., and 
graduated from the University of Pennsylvania Dental 
School in 1915. He enlisted in the Navy in 1917, one 
week after the United States declared war on Germany, 
and subsequently served as senior dental officer at U.S. 
naval bases and overseas, as well as at the U.S. Naval 
Academy, Annapolis, Md.; Naval Training Center, San 
Diego, Calif.; and U.S. Naval Hospital, St. Thomas, 
Virgin Islands. 

RADM Chandler was a member of the first dental 
officer class at Washington's Naval Dental School. In 
1923, after completing postgraduate work at North- 
western University, he became head of the prosthetic 
and operative departments at the Naval Dental School. 
In 1947, RADM Chandler, a specialist in prosthodon- 
tics, became assistant chief of the Bureau of Medicine 
and Surgery for Dentistry and chief of the Dental Divi- 
sion. He was responsible for establishing the first Navy 
schools for dental technicians at Bethesda, Md., Great 
Lakes, 111., and San Diego, Calif. He also was responsi- 
ble for establishing dental facilities in all ships and sta- 
tions having dental personnel. He became the dental 
inspector general in 1 948 and held this position until he 
retired in 1952. 

RADM Chandler was a member of the Capitol Clinic 
Club, American Denture Society, and American Dental 
Association; a diplomate of the American Board of 
Prosthodontics; and a fellow of the American College of 
Dentists. He held the Legion of Merit and the Hayden- 
Harris Award for his contributions to the history of 
dentistry. 



dant, Eleventh Naval District, should be submitted to: 
Commandant, Eleventh Naval District (Code 37), San 
Diego, Calif. 92132. Applications for other dental con- 
tinuing education courses should be submitted to: Com- 
manding Officer, Naval Health Sciences Education and 
Training Command (Code 5), National Naval Medical 
Center, Bethesda, Md. 20014. Applications should 
arrive six weeks before the course begins. 



Continuing education for Navy nurses . . . The Naval 
Health Sciences Education and Training Command will 
sponsor the following continuing education course for 
Navy nurses: 



Anesthesia Update (30 contact hours) 
Pensacola, Fla. 



5-7 Feb 1979 



Designed for Navy nurse anesthetists to present new concepts in 
methods and techniques in the field of anesthesia. 

The course is open to Nurse Corps officers not cur- 
rently assigned to an oversea billet. However, nurses 
assigned to Argentia, Newfoundland; Bermuda; Guan- 
tanamo Bay, Cuba; Keflavik, Iceland; and Roosevelt 
Roads, Puerto Rico, who have served at least six 
months on active duty, may apply. The course is also 
open on a space-available basis to Nurse Corps officers 
of the inactive Reserve. 

Nurse Corps officers wishing to attend the course 
should apply to the Naval Health Sciences Education 
and Training Command (Code 7), National Naval 
Medical Center, Bethesda, Md. 20014, following pro- 
cedures set forth in the BUMED Instruction 4651.1 
series. Applications should be submitted four to six 
weeks before a course begins. 



Dental continuing education courses . . . The following 

dental continuing education courses will be offered in 
February 1979: 

National Naval Dental Center, Bethesda, Md. 

Periodontics 5-7 Feb 1979 

Fixed Partial Dentures 26-28 Feb 1 979 

Eleventh Naval District, San Diego, Calif. 

Complete Dentures 20-22 Feb 1979 

U.S. Army Institute of Dental Research, Walter Reed 
Army Medical Center, Washington, D. C. 

Advanced Clinical Oral Pathology 5-8 Feb 1979 

Requests for courses administered by the Comman- 



AFD? courses offered . . . The Armed Forces Institute of 
Pathology will offer the following courses: 

Genitourinary Pathology 29 Jan -2 Feb 1979 

This course consists of a basic and comprehensive survey of the 
pathology of surgical diseases of the kidney, ureter, bladder, pros- 
tate, testis, penis, and urethra. The course is designed for urologists 
and will be presented by lectures, demonstrations, and the study of 
microscope slides. 

Applicants should be members of the Medical Corps 
of the Armed Forces or other federal services who are 
board eligible or certified urologists. Applications from 
qualified civilians will be considered on a space-avail- 
able basis. 



U.S. Navy Medicine 



Seminar and Workshop — Histopathology Techniques 5-9 Feb 1979 

The wet workshops will consist of bone techniques, eye techniques, 
brain techniques, and special staining techniques. These workshops 
will be held during the first two and half days. Selective training will 
be offered on Wednesday afternoon to include cryostat, kidney bi- 
opsy, spirochete staining, lymph node procedures, preparation and 
application of the H & E stain, knife sharpening, and the use of 
plastic (diatex) for tissue section transfer. The remaining day and a 
half will consist of lecture sessions. 

Applicants should be members of the Armed Forces 
or other federal services. Individuals must have at least 
one year's experience in a histology laboratory, and the 
training request must be made by the sponsoring 
pathologist. Use of a special application form is essen- 
tial. This form can be obtained by writing The Armed 
Forces Institute of Pathology, Washington, D.C. 20306, 
ATTN: AFIP/EDZ. Civilian applications will be con- 
sidered on a space-available basis. 

Pathology of Genetic Disease 12-16 Feb 1979 

The genetic aspects of various diseases due to point mutations and 
chromosomal aberrations will be discussed, using AFIP- accessioned 
case material to illustrate the pathologist's role in diagnosis. The 
pathologic effects of many of these diseases in specific organ systems 
will be reviewed. Lectures will cover the correlation of the clinical and 
laboratory features with the morphologic alterations of typical exam- 
ples of diseases due to trisomy aberrations, sex chromosomal 
anomalies, genetic abnormalities in sexual differentiation, autosomal 
and x-linked dominant and recessive point mutations. Specific 
genetic pathologic case problems accessioned at AFIP will be pre- 
sented to participants and their resolutions discussed. 



Applicants should be members of the Medical Corps 
of the Armed Forces or other federal services who are 
board eligible, or certified in pathology or other special- 
ties, with an interest in genetic diseases. Other military 
professional personnel and qualified civilians may 
apply on a space-available basis. 

Further information may be obtained by writing to 
the Director, Armed Forces Institute of Pathology, 
ATTN: AFIP/EDZ, Washington, D.C. 20306. 



Cold weather medicine and NBC warfare training . . . 

Two new training programs developed by the Naval 
Health Sciences Education and Training Command are 
now available to Medical Department personnel. 

• Cold Weather Medicine provides the necessary 
knowledge to operate effectively in areas of severe cold. 
The program is a self-study or classroom course con- 
sisting of instructional materials, objectives, lecture 
outlines, a glossary, an annotated bibliography, and an 



information source list. The format and contents are 
designed to help users choose portions relating to their 
professional and operational needs. 

• Medical Considerations of Nuclear, Biological, and 
Chemical Warfare provides information on handling, 
treating, and protecting personnel from the effects of 
NBC weapons. This program is a classroom course and 
consists of tasks, objectives, lecture outlines, a bibliog- 
raphy, and a general information section. 

Requests for these programs should be forwarded to: 
Commanding Officer, Naval Health Sciences Education 
and Training Command (Code 21), National Naval 
Medical Center, Bethesda, Md. 20014. 



Infectious disease course . . . The second annual Uni- 
versity of California, San Francisco course on Infectious 
Diseases in Clinical Practice will be held 27 Jan-3 Feb 
1979 in Sun Valley, Idaho. The course will emphasize 
clinical management and prevention of viral, bacterial, 
and mycotic infections, with emphasis on recent ad- 
vances in diagnosis and treatment. The course should 
be of interest to general and family practitioners, ob- 
stetricians-gynecologists, internists, pediatricians, and 
general surgeons. There will be lectures and specialty 
seminars. A comprehensive syllabus will be distributed 
to participants. 

For further information write to: Extended Programs 
in Medical Education, University of California, San 
Francisco, Room 569-U, Third and Parnassus Ave., San 
Francisco, Calif. 94143. Telephone (415) 666-4251. 



Clinical cytopathology postgraduate course . . . The 

20th Postgraduate Institute for Pathologists in Clinical 
Cytopathology will be given 23 April-4 May 1979 at The 
Johns Hopkins University School of Medicine and The 
Johns Hopkins Hospital, Baltimore, Md. The two-week 
program is designed for board-certified or -qualified 
pathologists and will provide an intensive refresher 
course in all aspects of clinical cytopathology, with time 
devoted to new techniques and special problems. 
Topics will be covered in lectures and informal confer- 
ences, and discussed over the microscope. A set of 
slides with text will be sent on loan to each participant 
for home-study during March and April before the 
Institute. Credit hours will be 120 in AMA Category 1, 
Applications should be received before 28 Feb 1977. 
For more details write to: John K. Frost, M.D,, 610 
Pathology Building, The Johns Hopkins Hospital, Balti- 
more, Md. 21205. 



Volume 69, November 1978 



Special Report 



The Surgeon General's 10th Annual Specialties 
Advisory Conference and Committees' Meeting 



This conference was held 12-15 September 1978 in 
Arlington, Va. Following is a report of the first plenary 
session of this annual conference. A concluding report 
will appear in the December issue of U.S. Navy Medi- 
cine. 

This report represents an edited (sometimes para- 
phrased or abbreviated) version of the remarks and 
presentations of specified individuals. Their comments 
do not necessarily reflect official views of the Navy 
Department or of the naval service at large. — Ed. 



Surgeon General's Keynote 
Address 

VADM W.P. Arentzen, MC, USN 
Surgeon General of the Navy 



At SAC IX, I devoted my remarks to a general state- 
ment of our major problem areas and some of the ini- 
tiatives we had taken to combat them. I stated my con- 
fidence in our ability to confound our critics. I remain 
confident today. 

I will speak of some problems this morning, but first I 
want to share with you my perceptions of some of the 
forces impacting on us as a Medical Department. 

Shortly after leaving the Office of the Secretary of 
Defense, James R. Schlesinger observed that, for 
Americans, security has been too widely viewed as a 
' ' given . ' ' Too little is it appreciated that the stability we 
still enjoy is a reflection and legacy of past American 
involvement and active leadership. He went on to de- 
scribe the more immediate invisible factors, such as the 
altered psychological stance of the United States, which 
is apparently withdrawing from the burdens of world 



leadership, with a resultant change in our national 
defense policy. 

This change in national defense policy has placed us 
in an era of competition for resources unmatched in our 
experience or in that of our predecessors. The size of 
our defense budget, although increasing in terms of 
total billions of dollars, has decreased in terms of real 
purchasing power, under the pressure of inflation. At 
this time, relative to the gross national product, our 
expenditure for defense is somewhat less than 6 % . 

The Navy and its sister services are undergoing ex- 
actly the same pressures. We are being asked to do 
more and more with less and less. This decrease in 
dollars with which to buy and run the ships we know we 
need has had some profound effects. As short a time 
ago as 1968, the Navy had 976 ships in commission. As 
of two months ago, we had 485 ships in our active fleet. 
Building costs are staggering. A carrier costs over $1 
billion. A fighter plane costs around $20 million. A 
strike cruiser will cost between $700 million and $900 
million. 

The health care environment, military and civilian, is 
undergoing similarly inflationary times. In the past 
year, the total health care bill for the nation was well 
over $100 billion. This approaches 10% of the gross 
national product. The government's share of this bill is 
approximately $50 billion. Inflationary pressures, as 
well as expansion of social programs, could double or 
even triple those already huge figures within the next 
10 or 20 years. 

As a result, nationally we see a continuing trend 
toward federal management of the nation's health care 
industry, as evidenced by increased structuring of the 
organization of health services delivery. 

Public Law 93-641 gave impetus to this structuring by 
establishing local, state, and regional entities within 
which federal and state funds would be dispensed 



U.S. Navy Medicine 



and managed. Similarly, public law has provided 
direction for the limitation of federal participation in 
capital expenditures, as well as a mechanism for moni- 
toring the quality of care under the aegis of professional 
standards review organizations. The passage of Public 
Law 94-44, with its emphasis on the delivery of primary 
care, provides the government for the first time with an 
obligated, controllable pool of professional health care 
providers. Implementation of the Occupational and 
Safety Health Act has provided teeth to federal efforts 
to control the safety of the work environment, but has at 
the same time created an expanded requirement for 
professionals and money to support this effort. 

For the Navy, the cost of health care this year will 
exceed $1 billion. One out of every six commissioned 
officers in the Navy is in the Medical Department. Is it 
any wonder that we are being analyzed, scrutinized, 
and directed to make every dollar count? 

In view of these changes in our environment, what 
have we done? Well, for too long we have kept our 
heads in the sand. Instead of coming to terms with any 
of the real issues confronting military medicine, we 
spent much of our time waging symbolic power 
struggles which prevented anyone from making deci- 
sions about anything. 

In 1973, the draft ended, and the era of the all-volun- 
teer force began. Since 1954 and the beginning of the 
Berry Plan days, we had welcomed up to a thousand 
superbly well-trained physicians every year. We used 
them and let them go their way. After all, another 
thousand would come next year. 

What a waste! Almost one third of the Navy Medical 
Corps turned over each year, and no one recognized the 
waste for what it was. 

We did this same thing with our other communities: 
dentists, Medical Service Corps officers, nurses, and 
corpsmen. With the draft, our supply was limitless. 
What need was there to conserve manpower, develop 
stability, train to requirements, or retrench and develop 
the initiatives needed for a truly responsive and re- 
sponsible health care system? 

Then it stopped. The draft was over. In a flurry of 
self-righteous excitement, we developed a spate of new 
programs designed to solve our problems. Each service 
had its own, but we still hadn't sensed our environ- 
ment. We still had not learned our lesson: that training 
was expensive, and that we could no longer afford the 
luxury of going it alone — in short, that we were in a dif- 
ferent era. Manpower was now expensive, approaching 
76% of our DOD budget. These programs failed the 
scrutiny of the analysts and are gone. 

Personnel is only one of our problems. Can we con- 
tinue to justify two hospitals in the same city, doing the 
same thing? Can we justify two separate medical sys- 
tems on the same island? 



Social economists — the analysts within and without 
— have recognized us for what we are: a potential test- 
ing ground for their systems and theories of health 
care, in which will be the shape of our national health 
care systems in the future. We are perfect for their use. 
We have a good health care delivery system in the mili- 
tary. We are a significant national asset. We offer a 
ready, prepared, responsive, sustainable force to be 
mobilized in time of natural crisis or conflict. If we 
didn't exist, we would have to be invented. We serve as 
a model, as the nation moves ever closer to the enact- 
ment of national health insurance. 

Because we are a federal agency, we must and 
should be responsive to the government's command. 
But just because of that, we must be especially careful 
not to become embroiled in pointless philosophic con- 
troversy or allow ourselves to be used as a test tube for 
every new notion. If we are to be the tail that wags the 
dog of the civilian medical sector, let us wag it with very 
careful deliberation. 

President Carter has stated his intention to introduce 
legislation establishing a national health insurance 
program of some sort during this Congress. Foresight 
and effective planning will help us avoid the paralysis 
and confusion that are certain to be associated with 
such a major change in American medicine. 

Our mission is unique. We must protect that unique- 
ness. Most of modern medicine is the same wherever 
we go, but there are some things in the military that are 
different, and they must be preserved. Perhaps we 
have placed too much emphasis on how similar military 
medicine is to civilian medicine. 

To a degree, we have been the authors of our own 
problems. Our patients have been educated by us to 
expect miracles in every situation. Our patients have 
forgotten how to be sick — antibiotics for every fever; 
mood elevators for every slight depression or fear of 
one; sleeping pills whenever sleep is delayed for a few 
minutes; organ transplants as one's own organs wear 
out. How can we blame our patients? And when esca- 
lating demands cannot be met, a bit more bloom comes 
off the rose. 

Competition for available resources will become ever 
keener, the conflicting imperatives ever more pressing. 

Success in some eyes will be measured more and more 
by compromise. We must be ever watchful in that re- 
gard. 

What does tomorrow hold? What will be the environ- 
ment in which we will be working? 

I think that certain trends now visible will continue. 
Present indications are that the Department of De- 
fense's role in policy development and resource 
management will expand. Under the aegis of the De- 
partment of Defense, health care regionalization will 
become more firmly established as a mechanism within 



Volume 69, November 1978 



which the military health care system will work. I 
expect that there will be increasing pressure for, and 
movement toward, integration of the entire military 
health care system with the civilian sector. 

There is little question that zero-based and capitation 
budgeting will serve as the basis for future funding. 
Much of this effort will probably stem from an enroll- 
ment system for all classes of our beneficiaries. The 
general delivery of health care will change. More of our 
efforts will be directed toward ambulatory health care. 

The Surgeons General are meeting regularly to 
identify our commonalities, share our resources, de- 
velop constructive supporting programs, and eliminate 
duplication. Equipment purchases are being coordi- 
nated. Programs are being directed toward the rightful 
dominant claimant, and joint training efforts are being 
initiated. We are placing increased emphasis on in- 
volving our facility managers in the decision- making 
process and providing them with the needed informa- 
tion and systemwide awareness required. Increased 
emphasis is being, and must be, placed on evaluation 
systems and indicators to tell us at each level how we 
are doing. We must emphasize cost containment and 
cost effectiveness, as well as quality of care, if we are to 
compete effectively. We must increase our ability to 
translate health care demands into programs and al- 
location of doctors, dollars, and personnel. 

What does all this mean for physician managers in 
our system? It will require innovative thinking. It will 
require inventive management. As health care general- 
ly comes under relentlessly greater government control 
and review, the opportunity to work and to exert an 
influence on the frontier should be an exciting area for 
imaginative, creative professional growth. 

But as much as we need physician managers, we 
need leaders more. Systems can be managed. People 
must be led. It is in this latter area that I am uneasy. 

During the past 12 months I have visited a large 
number of our facilities, from Japan to China Lake. I 
have been disturbed by some of the things I have seen, 
pleased by even more. But too many times I see 
evidence of resignation and malaise — what William 
Raspberry has called "big-picture paralysis." 

It is too easy to say that the problem is so immense, 
the difficulties are so huge, that one's own efforts don't 
matter. If we paint the picture big enough, we can paint 
ourselves right out of any part of the solution. The 
physician shortage, budget cuts, deteriorating facili- 
ties, and the crush of patients to be cared for are all big 
problems. But even so, individual decisions can have 
important results for individuals, even if they don't 
register statistically. Every corps man who reenlists as a 
result of your effort is important. Every patient who is 
satisfied with his clinic experience as a result of your 
compassion is important. Every physician who extends 



as a result of your example is important. They are all 
important. 

The point is not to relieve the Bureau or the Navy of 
the big-picture responsibilities. The point is that indi- 
vidual effort matters also. 

Another attitude which concerns me greatly is less- 
than-universal understanding and support of our 
mission. Support of the operating forces is the reason 
we exist, and service of these forces should be our 
highest calling. I have spoken with our scholarship stu- 
dents and find general understanding of the operational 
commitments of the Navy Medical Department — even 
enthusiasm. This is reinforced by the six- week OCS 
course at Newport. But much of that is dissipated dur- 
ing the GME-1 year, partly as a result of natural situa- 
tional inertia; partly because there are few visible role 
models; and, most disturbing of all, partly because of 
overt discouragement on the part of staff physicians at 
our teaching hospitals — including program chairmen. 

It is inconceivable to me that such action on the part 
of career physicians — that such failure to understand 
why we are here — can take place. That attitude must be 
turned around. 

One of my major goals as Surgeon General has been 
the removal of barriers between hospital-based and 
force- based personnel. It is clear that we have not come 
as far along that road as I would like. I need your indi- 
vidual efforts in this endeavor. 

I am concerned about our teachers. Even though 
numbers of physicians will not be a problem by 1981 or 
1982, the availability of good teachers, particularly in 
the subspecialties, will be a problem. We must retain 
them. We must retain every one of you in this room. 
Without you as role models, we won't keep those we 
need. 

Identify potential teachers early. Encourage their 
participation in your training programs. Solicit their 
ideas. While the generalist is of great value to the 
Navy, we cannot afford to become a corps of nothing 
but generalists. 

Some individual efforts are beginning to pay off. Ex- 
tension of medical officers is better this year than last, 
for the same time frame. During last year's SAC, we 
were predicting a physician shortfall between 250 and 
400. On 10 October 1978, that shortfall will be 169. That 
is a shortfall of 4.5%, considerably better than those of 
our sister services. Even that number is too large, but it 
is better than we had feared. 

We have received additional funds for conference 
travel — not enough, but more than before. Funds for 
equipment purchases continue at significantly higher 
levels. Our scholarship program is fully subscribed. 
Extension of the existing special pay legislation has 
been approved, and a new bill to improve and stabilize 
the special pay provisions has been introduced. 



U.S. Navy Medicine 



Some intangibles are beginning to emerge. The 
quality of volunteers seems definitely higher than in the 
recent past. The level of interest in military medicine 
appears to be higher. The Uniformed Services Univer- 
sity of the Health Sciences is a going concern, and we 
do have allies now. And these allies are beginning to be 
heard, in the Congress, in the Department of Defense, 
and in the Navy. 

I am convinced that facing the facts is always healthy 
and the way of wisdom, I pledge to you my intent to 
continue to do battle and to yield ground most grudg- 
ingly. 

Training is our life's blood, and I pledge my full sup- 
port to that effort. I remain confident; I remain proud. 

Someone once said, "You are as young as your faith, 
as old as your doubt; as young as your confidence, as 
old as your fear; as young as your hope, as old as your 
despair. When your heart is covered with the snows of 
pessimism and the ice of cynicism, then and only then 
are you grown old." 

I am feeling younger every day. 




CAPT Bryant 



OP-093: A Status Report 

CAPT E.M. Bryant, MSC, USN 
Office of the Surgeon General 

During these past 10 years of SAC meetings, we've 
seen and experienced numerous changes in our Navy 
Medical Department, many of which were driven by 
external forces. As a matter of fact, in the areas of re- 
source and organizational change, the number of ex- 
ternally driven "improvements" has made us wonder 
whether or not one more improvement might lead to 
total collapse. 



Today my purpose is to report to you another change, 
this time organizational. However, we are excited by 
this change, because it makes the Surgeon General an 
official member of the top-line management team: 
OPNAV (Echelon 1). It gives him resource sponsorship 
for all medical and medical training program elements, 
and it assigns him functional task sponsorship for medi- 
cal, Navy- wide. 

Briefly, that identifies OP-093. Actually, OP-093 is 
the Office of the Surgeon General in the Pentagon. The 
Surgeon General becomes director of a major support 
office (DMSO) in the Chief of Naval Operations organi- 
zation. 

One may ask, Why an OP-093 after all these years? 
How is it structured? And what is its status today? 

In September 1977, the Vice Chief of Naval Opera- 
tions expressed concern about several aspects of the 
Navy health care services system. Among these con- 
cerns were the medical organizational relationships 
with Navy; the fact that execution of health services was 
being directed by the Surgeon General with assistance 
from the staff of BUMED, a second echelon command; 
and the fact that the responsibility for health care ser- 
vices at the first echelon level — that is, OPNAV — was 
fragmented. 

As a result, the VCNO tasked RADM Synhorst (Ret.), 
OP-09E, as the study director to review the organiza- 
tion for health services. The study was completed 1 Jan 
1978, and the major findings supported the concerns of 
the Vice Chief. There were 16 medical billets scattered 
throughout 13 OP codes, with no central coordination. 

Of particular note is the fact that, by public law, the 
official title of the Chief of the Bureau of Medicine and 
Surgery is "Surgeon General." He is a second echelon 
commander. This placement of the Navy Surgeon Gen- 
eral differs from that of the Army and Air Force Sur- 
geons General. They are assigned to the Chiefs of Staff 
and function on the department headquarters staff. 

Generally, the service Surgeons General are per- 
ceived by higher authority to be the senior medical pro- 
fessionals on the headquarters staff, whether this 
placement exists or not. Over the years, medical func- 
tions in the Navy which should have been performed by 
the CNO staff were accomplished by BUMED. Fre- 
quently, recommendations on policy matters were 
made by BUMED without CNO awareness. More fre- 
quently, authorities above the CNO communicated 
directly with BUMED without the CNO's being in- 
formed. 

So the answer to question number one — Why an OP- 
093? — can be summarized as follows: 

CNO needed a central organizational unit to coordi- 
nate policy, guidance and direction, and professional 
and technical advice on all health-care-related pro- 
grams. In addition, this central office would be the focal 



Volume 69, November 1978 



FIGURE 1 



OFFICE OF THE SURGEON GENERAL 



SURGEON GENERAL 
OP - 093 

DEPUTY SURGEON GENERAL 
OP - 093B 



STAFF OFFICES 



OP - 

093A EXEC ASST 

093C SPECIAL ASST FOR 
OPNAV COORD 



PLANNING/PROGRAMMING 
DIVISION 

OP - 930 



OP - 
930C 

930D 

930E 



HD PROGRAMMING &. 
BUDGETING BR 

HD LOGISTICS <fc MEDICAL 
SUPPORT BR 

HD DOD &. LEGISLATIVE 
AFFAIRS BR 



PROFESSIONAL DIVISION 






OP - 931 




OP - 








931 C 


HD 


TRAINING BR 




931 D 


HD 


R&D BR 




931 E 


HD 


DENTAL BR 




931F 


HD 
BR 


OPERATIONAL 


MEDICINE 



point for dealing with higher authority, for sponsorship 
of resources, and for appraising health care efforts 
Navy -wide. 

The second question was, How is OP-093 structured? 

VCNO memo of 11 April 1978 directed establishment 
of a new DMSO— OP-093— to be entitled the "Office of 
the Surgeon General." Figure 1 shows that organiza- 
tion. In addition to the Office of the Surgeon General, 
we have two major divisions — a Professional Division 
and a Planning/Programming Division — that will oper- 
ate in the Pentagon. 

This action made explicit that which has always been 
implicit: that the Surgeon General is the principal advi- 
sor to the CNO on medical program matters. 

Specific functions assigned to OP-093 are to: 

1. Develop Navy health care program policy and 
guidance and provide professional and technical advice 
on matters pertaining to naval health care. 

2. Coordinate, as a sponsor for designated health 



care programs, with other sponsors with regard to 
Navy/Marine Corps health requirements. 

3. Review and appraise the capability of the Navy 
Medical Department to respond to contingencies. 

4. Review and appraise the performance of the Navy 
Medical Department in safeguarding and protecting 
the health of authorized beneficiaries. 

5. Act as central point of contact for naval health 
care matters involving coordination within OPNAV. 

6. Act as central point of contact for health care mat- 
ters concerning the Marine Corps. 

7. Provide backup for meetings on health care mat- 
ters. 

8. Assist the DCNO for Manpower (OP-01) in the 
preparation of plans, policies, and studies pertaining to 
Navy medical manpower requirements. 

9. Assist the DCNO for Logistics (OP-04) in the 
preparation of plans, policies, and studies pertaining to 
medical logistical support, including the prepositioned 



10 



U.S. Navy Medicine 



War Reserve Material Program. 

10. Assist OPNAV mission and resource sponsors in 
programs that have health care impact. 

11. Advise and assist the CNO in exercising com- 
mand responsibility over the Bureau of Medicine and 
Surgery. 

12. Act as mission sponsor for medical. 

13. Act as resource sponsor for medical and medical 



FIGURE 2 

ORGANIZATIONAL STRUCTURE 



CHIEF OF NAVAL OPERATIONS 



DIRECTOR, MAJOR 
SUPPORT OFFICES 

(OMSO) I 



OP-090 DtR, NAVY PROGRAMMING 

PLANNING 
OP-09B ASST VICE CHIEF OF 

NAVAL OPERATIONS 
OP-093 OFFICE OF THE 

SURGEON GENERAL 
OP-OS4 DIR. COMMAND & CONTROL 

& COMMUNICATIONS 
OP-095 DIR, ASW A OCEAN 

SURVEILLANCE PROORAM 
OP-O08 INSPECTOR SENERAL 
OP-0O9 DIRECTOR OF NAVAL 

INTELLIGENCE 
OP-Q9R DIRECTOR OF NAVAL 

RESERVE 



CHIEF 
NAVAL j 

personnel! 

(CNP) 



ECHELON 1 



DEPUTV CHIEF OF NAVAL 
OPERATIONS 

(OCNO) 



OP^OI MANPOWER 
OP-D2 SUBMARINE WARFARE 
0P-03 SURFACE WARFARE 
OP -04 LOSISTICS 
OP-OS AIR WARFARE 
OP-06 PLANS, POLICY 4 
OPERATIONS 



ECHELON 2 



CHIEF 

ED & TRNO 

(CNET) 



CHIEF 

BUREAU OF 

MED&SURG 

(BUM ED) 



1 

CHIEF OF j 
MATERIAL I 

(CNM) 



FLEET 
COMMANDERS 
IN CHIEF 
(CINCS) 



FIGURE 3: Interface Between BUMED and OP-093 

OP-093 (SG) Chief BUMED 

Coordinate OPNAV efforts Provide background data and 
in health care field analysis to OP-093 

Develop health care policy Translate and implement 

policies to BUMED com- 
mand activities 



Focal point for higher 
authority 

Resource sponsor for medi- 
cal and medical training 
programs 

Appraise health care ef- 
forts navywide 



Focal point for field activities' 
programs and problems 

Provide detailed resource 
data to support OP-093 re- 
source efforts 

Evaluate performance and re- 
source utilization of BUMED 
command activities 



training program elements. 

Functions 12 and 13 assign to the Surgeon General 
those normal CNO staff programming functions of re- 
source sponsorship and functional task sponsorship. 
Prior to establishment of OP-093, these functions were 
assigned to other OPNAV offices. 

In his implementation memo of April 1978, the Vice 
Chief of Naval Operations assigned OP-093 a number of 
specific tasks. I will mention three, just to give you 
some notion of our charter and our charge. 

First, the Surgeon General will program the medical 
resources and present the developed medical programs 
to the OPNAV decision-making bodies for the first time 
during the POM-81 cycle. Right now, the OP-093 staff 
is working with the BUMED and HSETC staffs on de- 
veloping and presenting training programs for fiscal 
years 1981-1985. 

Second, OP-093 is to emphasize, in Defense Health 
Council deliberations, medical readiness and contin- 
gency requirements for medical support, and is to in- 
stitute procedures to keep the CNO and the VCNO 
aware of initiatives and developments. 

Last, OP-093 will discourage new studies in health 
care, pending completion of review and action on past 
and current studies. (In a recent point paper, we identi- 
fied 280 studies and reviews to the CNO.) 

This brings us to our final question: What is the 
status of OP-093 today? 

I am pleased to report that the life- sustaining equip- 
ment has been detached from the OP-093 patient. The 
organization is alive and on its own. Our military staff is 
assigned and in place, with equipment and telephones, 
at the Pentagon on the fourth floor, "B" Ring, Rooms 
456-464. The OP-093 team has received enough tasks to 
last two years, and new tasks arrive daily. 

Figures 2 and 3 show the organizational structure 
and the envisioned interfaces between OP-093 and 
BUMED. 

The Surgeon General (OP-093) is located at Echelon 
1 , along with all other directors of major support offices 
and Deputy Chiefs of Naval Operations, while the Chief 
of BUMED sits at the Echelon 2 level, along with all 
other major claimants. The interface envisioned be- 
tween OP-093 and BUMED is not unlike that which 
exists between OP-04 (the DCNO for Logistics) and the 
Naval Facilities Engineering Command. Primarily, the 
OPNAV organization operates in the upward arenas, 
while the Echelon 2 commands support the OPNAV 
organization and manage the field activities. 

With medical teams at both of these echelons work- 
ing together, and with resource and functional task 
sponsorships assigned to OP-093, the Surgeon General 
has a greater opportunity to gain visibility for Medical 
Department programs and problems, and to obtain re- 
sources to meet medical requirements in the future. 



Volume 69, November 1978 



11 



Contingency Planning 

CAPT J.J. Quinn, MC, USN 

Deputy Director of Program Planning and Analysis 

BUMED Code 02-1 

I intend to address three topics: first, what contin- 
gency planning is; second, why it is important; and, 
third, how contingency planning should affect the selec- 
tion process for specialty training. 

BUMED contingency plans are, simply, to use the 
resources of the Medical Department to meet the re- 
quirements of the operating forces. These require- 
ments may range from a need for a single physician to a 
need for a surgical team to a need for the total re- 
sources of the Medical Department in support of an all- 
out war. 

BUMED has initiated and maintains several pro- 
grams to ensure its ability to meet these requirements. 
These programs include organizing surgical teams, 
training medical regulating teams, maintaining pools of 
physicians for duty with the fleet, and requesting funds 
for seven 1,000-bed fleet hospitals to provide support 
for a major war. 

To grasp the importance of contingency planning to 
the Medical Department, it is first necessary to under- 
stand the Department of Defense planning procedure. 

The first and most important point is that BUMED 
has neither the responsibility nor the right to create 
plans. In the great division of the world into "doers" 
and "providers," the Navy Medical Department falls 
with the providers. We make plans to support the plans 
the doers make. That is, they tell us what they need, 
and we make sure they get it. But who are "they"? 

The cornerstone of the DOD planning process is a 
document called the "Consolidated Guidance," which 
is produced by the staff of the Secretary of Defense, on 
direction from the President. After Presidential review, 
it is published over the signature of the Secretary of 
Defense. It directs the services to plan to achieve spe- 
cific missions, and provides guidelines which define 
those missions. 

These guidelines are followed by the Joint Chiefs of 
Staff in formulating the Joint Strategic Capabilities 
Plan, or JSCAP. The JSCAP provides an assessment of 
the potential enemy threat in each area of the world and 
serves as guidance to the commanders in chief of vari- 
ous theaters in their formulation of operations plans, or 
OPLANS. 

OPLANS are unconstrained. They specify the re- 
quirements which must be met in order for the CINC to 
defeat the enemy, and leave it up to the providers to 
assure that these requirements are met. It is here that 
BUMED and other resource and program sponsors 
enter the picture. 



Each OPLAN has an associated medical annex as a 
part of its logistics section. The medical annex states 
the requirements for medical support of that particular 
OPLAN. BUMED's responsibility is to review that an- 
nex and to devise plans to support it. If, as is often the 
case, current Medical Department assets are not ade- 
quate to meet the requirements, we must develop pro- 
grams to reduce or eliminate the shortfall. (The fleet 
hospital is one such program.) 

The planning process is mission oriented. It may 
seem far afield from our daily activities in the medical 
centers, and you may think it remote to your purpose 
here. It is not. The Consolidated Guidance makes the 
connection, in that it directs the services to determine 
their appropriate peacetime sizes by their wartime re- 
quirements. 

The following is quoted directly from the Consoli- 
dated Guidance: 

The primary mission of the military medical system is to plan, pre- 
pare for, and provide medical support for military operations in ac- 
cordance with approved planning scenarios. This includes: 

A. Health care for active-duty members. 

B. Medical support for military contingencies. 

C. Sufficient mobilization base for rapid expansion of military 
medical capability in the case of major war. 

D. Rotation base to facilitate managing the substantial volume of 
transfer and training functions inherent in providing medical support 
for military forces. 

E. Educational and training programs necessary to provide a pro- 
fessional environment attractive to well -qualified health profession- 
als. 

The secondary mission of the military medical system is to provide, 
on a space-available basis, care to eligible patients other than active- 
duty members. 

The Navy Medical Department is held to these guide- 
lines in the planning, programming, and budgeting 
system. We must make an annual submission of our 
wartime requirements, calculated in accordance with 
the current Consolidated Guidance, and must show that 
these requirements justify our peacetime size. Our 
statements are subjected to intense scrutiny by Depart- 
ment of Defense analysts and Government Accounting 
Office and Office of Management and Budget staffs. 
Insofar as they detect logical flaws, inconsistencies, or 
ambiguities in the statements of requirements, they 
recommend decrements in our programs. 

We face many problems in preparing to fulfill our 
mission, not the least of which is that the optimum spe- 
cialty mix for the treatment of our peacetime population 
is different from the optimum mix for our predicted 
wartime patient load. This fact has not escaped the 
budget analysts, who persist in suggesting that the 
mismatch of peacetime specialties and wartime re- 
quirements demonstrates that we are unable to fulfill 
our primary mission with the physician assets we have. 



12 



U.S. Navy Medicine 




SAC panel discussion: RADM R.G. Williams, Jr.; VADM W.P. Arentzen; RADM Stephen Barchet 



They then argue that, since those assets would not 
meet wartime requirements, we should not maintain 
them in peacetime. 

Our only defense is to show that physicians practic- 
ing in one specialty in peacetime can fulfill another 
function in wartime — that, for instance, a peacetime 
specialist in OB-GYN could do general surgery in a fleet 
hospital in wartime. Our training programs must assure 
that kind of cross-specialization if they are to survive 
the budgeting cycle. 

The equivalent of the total personnel assets of the 
Medical Department might be required for in-theater 
support of a major war. The training programs we sup- 
port must assure that our people are ready to deploy, 
and that they have the skills they will need to do so. 

Given the intense scrutiny that every item in the 
DOD budget now receives from Congress, the Execu- 
tive Branch outside DOD, and within DOD itself, there 
can be only one interpretation of our circumstances: 
Unless the Navy Medical Department can show that its 
services are available and ready to fulfill its primary 
mission, and unless it can show that its programs of 
training support that readiness, it cannot hope for sup- 
port in the budgeting process. In short, our survival 
depends on our ability to convince the Chief of Naval 
Operations, the Commandant of the Marine Corps, and 



their civilian superiors that we are able and ready to 
carry out our mission. The only arguments we can make 
that will carry any conviction are to respond promptly 
and fully to operational requirements, and to propose 
programs to relieve inadequacies in our ability to 
support those requirements. 

It may lend a note of urgency to the problem for you 
to remember that the Secretary of the Navy testified 
before the President's Commission on Pay and Benefits 
to the effect that it was not necessary for the Navy to 
maintain a large peacetime Medical Department. We 
have, since then, prepared a briefing for him which 
succeeded in convincing him to alter his opinion. The 
fact remains, however, that we are viewed in many 
quarters as expensive, cumbersome, and dispensable 
in favor of civilian sector care. 

All of which brings us to the question, How should 
contingency planning influence selections for specialty 
training? 

Let me say first that we cannot compromise the quali- 
ty of our health care system in any way. Those selected 
for advanced training in our system must be highly 
qualified academically, and of unimpeachable charac- 
ter. 

But let me add that we cannot compromise our mis- 
sion through failure to consider it in the selection 



Volume 69, November 1978 



13 



process. We must have training programs which pre- 
pare our students for their contingency, as well as their 
peacetime, roles. And we must have students in those 
programs who recognize that their responsibilities as 
naval officers stretch beyond the medical centers, and 
who are willing to fulfill those responsibilities when 
required to do so. 

Today we have one surgical team and a two-physician 
augmentation unit at sea with the Marine Corps, in 
addition to the physicians, nurses, Medical Service 
Corps officers, and corpsmen normally assigned to 
those Marine Corps units. We have a medical care sys- 
tem, reaching from Yokosuka to Naples, which may be 
called upon tomorrow to support contingencies ranging 
from natural disasters to full-scale war. 

The specialty training programs which cannot be 
identified with some aspect of contingency support, 
whether directly or through additional cross-specialty 
training, are in a most precarious situation. Likewise, 
the Medical Department cannot afford to train, or to re- 
tain on active duty, anyone who will not recognize his 
responsibilities and willingly fulfill them. 

It is not enough, however, to select the right people 
for the job. Our training programs, as I have said, must 
be adequate to prepare our students to fulfill the con- 
tingency mission of the Medical Department as well as 
to serve our peacetime patients. Part of the task you 
assume here must be to define what additional training 
would be necessary to permit practitioners of each spe- 
cialty to serve effectively in a combat theater. 

The specialty mix required for treatment of combat 
theater casualties is, as you would expect, heavily sur- 
gical. The requirements for anesthesiologists and for 
surgeons in all specialties far exceed our peacetime as- 
sets. The questions you must address are these: What 
role would a specialist in my field play in field service 
with the Marine Corps? with the fleet? in a definitive- 
care facility in a combat theater? And, most important, 
how can the operational versatility of such a specialist 
be strengthened by emphasizing segments of specialty 
training, or by adding to if? 

Let me close with a plea that you undertake the edu- 
cation of our younger physicians and of all members of 
the Medical Department team. As outstanding medical 
specialists, you enjoy the professional respect and 
admiration of all your colleagues and subordinates. 
They are, to a great extent, guided by your example. 
Insofar as you show them that the Medical Department 
must be committed to its primary mission, they will 
make it so. 

Yet it is all too easy to become immersed in the job at 
hand and come to see the Navy as an adjunct to our 
hospitals, rather than vice versa. It is our responsibility 
to see to it that those we train remember those we are 
here to serve. 



The peacetime posture and attitude of the Medical 
Department are made manifest to the operating forces 
through the people we assign to duty with them, and 
through the personnel of the surgical teams we deploy 
with them. As we all know, however, duty with the 
operating forces or deployment with surgical teams is 
frequently viewed with distaste by junior and senior 
members of the Medical Department and is either 
actively avoided or accepted with bad grace. We also 
know the reason for this: The duty is often boring. Few 
patients, if any, require more than routine treatment, 
and we are constantly aware that the work is piling up 
for us, awaiting our return. And duty with organic 
Marine assets can be uncomfortable as well as boring. 

The point we must remember, and must drive home 
to those we train, is this: The operating forces are not 
conducting exercises for the fun of it. They are not, to 
use a phrase too often heard from physicians, wasting 
our time playing games. They are exercising so as to be 
ready to perform their mission, and they have a right to 
our support. 

I need not harangue you on this subject, because you 
know these realities already. I must urge you, however, 
to bring those you train to share your realization. If they 
do not, they will alienate our natural allies in the line 
and Marine Corps and, in so doing, seal the fate of the 
Medical Department. 

It has not been my intention to convey an overly 
alarming or melodramatic impression of where we are 
and what we must do; nor do I suggest any slackening 
of our efforts to provide superb medical care to our 
peacetime patients. Rather, I suggest that a full recog- 
nition of our potential wartime responsibilities is the 
best guarantee of our continued ability to provide the 
best of health care to all our patients. 



Medical Readiness for Opera- 
tional Contingencies 

RADM H.A. Sparks, MC, USN 

Deputy Surgeon General and 

Assistant Chief for Headquarters Operation 

At the outset of my remarks, may I offer one simple 
observation: that is, that each and every one here today 
has a very special involvement in the status and effec- 
tiveness of our Medical Department's operational med- 
icine capability. 

That is why we are here! It is our primary responsi- 
bility to conserve the military manpower of the Navy 
and Marine Corps. In peacetime we must maintain the 
health status of our forces through health education, 



14 



U.S. Navy Medicine 



health protection, and personal health care, all of which 
has but one goal: readiness. Simultaneously, the Medi- 
cal Department itself must be ready to make a prompt 
transition from its peacetime posture to a well-trained, 
properly outfitted, and carefully positioned worldwide 
Medical Department force. 

We are an integral part of the naval warfare system 
of our nation. Our contribution to the nation's defense 
is to provide medical support to those naval forces 
whose mission is to control the sea lanes and to project 
power ashore. 

Where did we come from? We were born of the line. 
Our birth as an organization came from recognition by 
the line that our skills were desirable and needed— and, 
indeed, medical personnel first appeared on board 
ship. 

Today we have some 728,000 Navy and Marine Corps 
men and women in uniform. We have an additional 
136,000 direct-hire civilians working in such facilities as 
naval shipyards, ordnance plants, and naval air and 
ship-rework facilities. 

Our Surgeon General has set as our first priority the 
health care support of the operating forces. Our second 
priority is occupational and industrial health services to 
our civilian workers. Thus, we have medical responsi- 
bility for at least 860,000 people in our two top priority 
areas. 

Another factor that must be considered is the stra- 
tegic deployment of our naval and Marine forces over 
the entire surface of the globe. Although our logistic 
capabilities have increased, through the marvels of 
technology, so that we can move men, materials, medi- 
cal facilities, and the like with relative ease, we often 
find ourselves engaged in new and hostile environ- 
ments. The Medical Department of today's Navy must 
be prepared for contingencies in every area of the 
world, under any circumstance. 

It is extremely important for us to understand the 
concept of a worldwide contingency health care system, 
for the resources to support it are being justified by 
carefully articulating such a concept, including the 
education requirement — which, of course, is why we 
are here today. 

One hundred years ago, when the fleet began con- 
verting to steam boilers, great concern was expressed 
by fleet surgeons over problems created by stifling 
heat. Early changes in structural design, engineering 
changes, and limited watches for personnel were 
accomplished because of the concerned action of medi- 
cal officers. 

I can assure you that we still have those very same 
concerns today. And to that list of circumstances that 
impact on our operating forces, we can add such items 
as noise, asbestos, toxic paints and chemicals, ionizing 
and nonionizing radiation, lasers, and physical and 




RADM Sparks 

psychological stress caused by such things as G-factors 
or prolonged duty under the polar icecap, just to name a 
few. 

Not only must we keep in touch with the latest de- 
velopments in the medical /scientific community, but 
we must also keep abreast of the technological develop- 
ment of the Navy itself. We must be fully aware of both 
and be able to match both at any given point in time. 

Perhaps the most awesome circumstance today is the 
technology of war itself, and the possible adversary we 
would face in such an event. There can be no doubt that 
the ultimate aim of communism remains the domina- 
tion of the world and the elimination of the free-world 
democracies. There is also no doubt that the quickest, 
surest way of achieving this would be military victory 
over the West, if we were to relax our vigilance and 
strength. To this end, both sides have built up the 
greatest and most terrible array of military weapons 
known. 

Since World War II, the Soviet Navy has been trans- 
formed from a basically coastal defense force into an 
open-ocean force, capable of carrying out general pur- 
pose naval missions supporting Soviet global political 
and military objectives. As of 1 July 1977, the Soviet 
fleet comprised approximately 2,875 ships. In numbers 
alone, that represents a fleet more than six times the 
size of ours. 

There's no disagreement that a major war between 
the United States and the Soviet Union would be devas- 
tating to both sides and of relatively short duration. 
Quick-strike capabilities can bring the destruction of a 
nuclear attack to our land-based activities within a 
matter of hours. Fifty-five important U.S. cities, with 



Volume 69, November 1978 



15 



some 71 million people, are located within 530 miles of 
the 100-fathom-depth curves of both the Atlantic and 
the Pacific Oceans. Civilian and military casualties 
would run into the millions. Our major cities would be 
leveled, and our way of living, as we know it today, 
utterly destroyed. The responsive ability of the survi- 
vors would depend solely on offensive, retaliatory, 
mobile naval forces. 

Let me compare the suddenness and short duration 
of such a war with what happened to us in World War 
II. After the attack on Pearl Harbor, we fought what 
amounted to a holding and delaying tactic until produc- 
tion and manpower reserves of the country were geared 
up to meet and defeat the enemy. At the same time, our 
medical people were learning as they went along. 

Some say that combat medicine is not something that 
you can really get prepared for — that you only learn 
under combat conditions. Well, we'd better reject that 
notion, because I can tell you we won't have the time to 
learn as we go along. 

In the Navy Medical Department, every uniformed 
man and woman must be ready within hours to take up 
his or her position in support of the operational forces of 
the Navy and Marine Corps. Each one of us had better 
know what we are doing under every conceivable cir- 
cumstance. 

The degree of readiness we attain during peacetime 
and our response time to varying levels of contingencies 
are the true measures of our competence as Navy medi- 
cal officers. 

What, then, should be the posture of the Medical 
Department today with regard to operational medicine? 

The choice is not really ours; it has already been 
made for us by those in authority to make such choices. 
I've already told you of the priorities set by the Surgeon 
General. These priorities are established by the Chief 
of Naval Operations. Jointly, their objectives are to 
"give the highest priority to health care support of the 
operational forces" by providing "full preventive and 
curative medical and dental services to active-duty 
naval personnel." 

The reality of our commitment to the operational 
mission can be found in the CNO's budget, which gives 
us our financial life's blood. Each and every billet in 
that budget is supported by its contingency require- 
ment in support of the operational forces in case of 
mobilization. In plainer words, the only justification for 
any man or woman to be in the uniform of the Medical 
Department in peacetime is based totally on a projected 
wartime need. 

In our considerations of how we make ourselves 
operationally ready, there are two areas that deserve 
our special attention. 

First, all members of the Navy Medical Corps must 
recognize and appreciate their dual roles as military 



medical specialists and as clinical specialists. We are 
not structured for personnel who see the Navy Medical 
Department as just another place to practice clinical 
medicine in the traditional sense. The acceptance of 
this dual responsibility cannot consist only of a tacit 
cerebral acknowledgment that, in case of war, "I will 
go forth and do my duty." Acceptance means we must 
be ready to assume those duties, and readiness re- 
quires us to be willing to devote a portion of our time on 
assignment with the operational forces either afloat or 
in the field. Any member of the Medical Corps who 
cannot accept the dual military-clinical role that sets 
him apart from his civilian counterpart has no business 
in the service. He or she should seek employment else- 
where. 

Second, all medical education programs and work 
experiences must address themselves to the readiness 
preparation of Medical Corps personnel. The training 
education experience in peacetime must prepare us for 
all manner of circumstances, environments, and con- 
tingency situations. 

By this I mean to emphasize that the training inter- 
face between clinical and operational medicine must be 
so close that no boundary can be discerned. To suggest 
that the two should not be mutually complementary is 
to deny reality. However, I must acknowledge that our 
current training programs are just not adequate to meet 
all fleet operational needs. 

To remedy that deficiency, an operational medicine 
BUMED-HSETC training seminar-workshop was con- 
vened in San Diego on 12 June 1978, at the direction of 
the Surgeon General. The assigned tasks of that as- 
semblage were to: 

• Review and inventory present operational medi- 
cine practices in their relation to training programs and 
requirements. 

• Identify specific knowledge and skill deficiencies, 
and recommend steps to overcome them. 

• Recommend a general system of operational medi- 
cine training. 

• Recommend career pathways of training and de- 
velopment in operational medicine. 

• Construct initial curriculum outlines for selected 
operational training programs. 

I am pleased to report to you that all of the above 
tasks assigned to the workshop were accomplished. 

With respect to Medical Corps officers, the following 
recommendations were set forth: 

• All medical officers entering active duty will attend 
30 days (81 hours) of military indoctrination at Newport, 
R.I. 

• Medical officers who have not done so will com- 
plete the GME-1 year. 

• Medical officers may complete additional GME 
training in selected cases. 



16 



U.S. Navy Medicine 



• Medical officers who may have completed all post- 
graduate training may be assigned to NRMCs or go 
directly to the Operational Medicine Common Core 
Training Course. Such schools are to be established in 
San Diego and Norfolk. The course curriculum will re- 
quire 161 hours of study, and features occupational, 
industrial, and preventive medicine. All medical offi- 
cers assigned to operating forces will attend and then 
proceed to additional operational training at the field, 
surface, flight, or undersea medicine training facilities, 
or to an operational tour in research facilities. 
■ • Upon completion of the first operational tour, the 
medical officer may select additional professional train- 
ing in residency, fellowship, or advanced degree pro- 
grams. Some candidates may be selected for advanced 
special service schools. 

I believe that the implementation of this task-ori- 
ented program will provide a cadre of 3,650 physicians 
who can serve with great satisfaction as qualified mili- 
tary-clinical specialists. 

In summary, may I say that we must never lose sight 
of the job we have to do, and we must do that job with 
excellence. 



Medical Department Personnel: 
Issues and Initiatives 



RADM R.F. Milnes, MC, USN 
Assistant Chief for Human Resources and 
Professional Operations 
BUMED Code 3 



This is a time for me to consider your ideas, your con- 
cepts, and your plans— and a time for you to know what 
we are thinking and doing to provide you with the tools 
to give our patients the kind of medical care we know 
we can. 

I have come to Code 3 with a positive spirit. I accept 
the concept that we are managing in an era of constant 
change, and that it is mandatory to accept this pace, 
which is fast, uneven, and certainly complex. It is also 
important to approach our tasks with the view that we 
can effect some positive results right now — and with 
the aim to do more in ensuing years. I can assure you 
that my staff and I believe we can. 

Our assets are our people, our product, and our ac- 
complishments. Our problems, simply stated, are ac- 
cession, retention, and attrition. But manpower is 
people, not hardware. If hardware doesn't work, it 
breaks— and people react if things aren't right. 
Realizing this, I pledge my office to do what it can to 



provide people with the opportunity to grow and attain 
a quality of professional life that they seek. 

My goal is to provide full support for operational 
commitments and equally strong support for our train- 
ing programs. The success of this dual support is vital 
for our future and our viability as a Medical Depart- 
ment. 

I intend to create a sense of integrity in our inter- 
actions with you. It is necessary for all of us to com- 
municate. Our effectiveness requires your help and 
involvement. 

I view one general problem, in particular, with con- 
cern, and I solicit your support. I would ask all of you in 
positions of leadership to embrace wholeheartedly our 
efforts to demonstrate that operational tours are valu- 
able—that such a tour is a positive challenge to anyone 
who has chosen to become a part of the Navy, and that 
this arena is one where much can be accomplished. 

Our operationally deployed GME officers will do 
much to lend credence to our efforts and help solve this 
highly visible problem. However, we need to work to- 
gether to turn this around to our advantage. This is 
crucial for our service integrity. 

Next year, we will place 280 primary care medical of- 
ficers in operational billets. That number is our commit- 
ment to the operation of the fleet and to the Marine 
Corps. 

We do have some very positive aspects of our in- 
ventory. This year, 557 scholarship students have 
joined us, and not all of these students are entering at 
the first-year level. This certainly gives the coming 
years a much healthier look than we have been expe- 
riencing. These students are of high quality and come 
from well over 1,000 applicants— they really look good. 

Family practice programs are delivering family prac- 
tice specialists in increasing numbers. These physi- 
cians are in demand, and we are detailing them to more 
diverse locations, where they have been welcomed with 
open arms by our consumers. 

The Physician's Assistant Program starts again in 
1979, with an expected increased output of these 
valuable extenders, who will be able to help us not only 
in our clinics but also in certain operational areas that 
can utilize their expertise. We have already chosen a 
physician's assistant consultant, who will be stationed 
at the hospital in Charleston but will be responsive to 
all physician's assistants. He will provide an important 
interface with us at BUMED and lend a great deal of 
stability to the physician's assistant community. 

The Nurse Corps has gained billets, and the people to 
go with them will increase the overall nursing com- 
munity to help cope with the increasing demands made 
on nurses by new JCAH directives. These directives 
will require your attention, as they call for significant 
changes in nursing assessment and care plans. For 



Volume 69, November 1978 



17 



example, a patient classification system will be imple- 
mented in our hospitals, in order to determine patient 
needs for nursing care, and the long-range and daily 
nurse staffing requirements within the hospitals. 

Physician recruiting has changed little from last year, 
numberwise. But quality has improved a great deal, 
and American-trained physicians are more numerous, 
even if on a small scale. We expect to recruit close to 
200 medical officers this year. 

Last year, 55% of those recruited were FMGs, and 
45% were American trained. This year these percent- 
ages are reversed, and those FMGs who apply are more 
apt to have their citizenship. We like this trend, and 
you can affect it significantly by being responsive to 
your area recruiters. 

The Variable Incentive Pay Program has been ex- 
tended two years, and a new bill has come along to in- 
crease professional pay and eliminate some of the 
inequities and vexations of the present system. Also, 
there are strong indications that a pay initiative will be 
promoted for our enlisted personnel this next year. 

The lack of ancillary help which all hospitals have 
experienced, and which is the source of adverse com- 
ments from our physicians, is getting attention. One 
hundred forty-four additional ceiling points have been 
added to our inventory in this problem area; however, 
recent events indicate that Congress once again intends 
to seek increased decrements in our civilian inventory. 
We have not solved this problem, but we are working 
on it. 

Our major concern this year has been the loss of criti- 
cal specialists. We are short in areas all too familiar to 
you: orthopedics, radiology, psychiatry, OB-GYN, and 
surgery. We don't have an immediate fix, but we do 
know there is something that will help, and that comes 
under the heading of personnel counseling. This needs 
your utmost attention, as it can limit attrition and in- 
crease retention. The devoted interest of a commanding 
officer, a director of clinical services, or a department 
chairman in the younger staff is, without question, 
where retention efforts are most effective. 

When you can honestly project your positive spirit 
about Navy medicine, it is productive. I don't feel in 
any way that this request is passe, because it is one of 
the more commonly stated reasons physicians give 
when they leave the Navy. 

Your efforts to retain our corpsmen are invariably 
worthwhile. Please take the time to talk with them and 
help them plan a future. 

The decreased opportunity for promotion has been a 
negative factor in its effects on attrition and retention. 
This year, for Medical Corps officers, there will be a 
90% opportunity to be selected as commander, instead 
of the 80% of last year. I am pleased that this has been 
turned around, and that we will be able to extend the 



opportunity to attend executive medicine courses to 
selected lieutenant commanders in the Medical Corps. 
The situation with regard to corpsmen is receiving a 
great deal of study and attention. For example, the 
Navy Occupational Task Analysis Program (NOTAP) is 
a study coming to fruition in the spring. This very de- 
tailed and extensive computerized evaluation of jobs 
filled by our corpspeople will let us upgrade occupa- 
tional standards, help us learn about job satisfaction, 
and allow us to compare jobs for commonality or dis- 
tinctiveness. It will help us utilize our corpsmen better, 
which unquestionably we need to do. We also can, with 
hard data, pursue our requirements more effectively 
with those who control the budget and distribution of 
our corpspeople. 

We need new programs to assist our E-8 and E-9 
community in gaining increased supervisory manage- 
ment skills. These are being developed and can signifi- 
cantly enhance the value of senior enlisted staff in all 
segments of the Medical Department. I strongly en- 
dorse greater involvement and utilization of the master 
chiefs and senior chiefs of our commands, and I urge 
you to do this also. They are in a position to unite a com- 
mand and help you obtain the optimum from Hospital 
Corps assets. 

In recent years, we have never been fully able to 
compete for manpower in Congress. Now we have the 
oncoming data from SHORSTAMPS, our Shore Re- 
quirements, Standards, and Manpower Planning 
System. The facts generated by this study give us a 
defensible manpower planning system which, when 
presented to Congress, will substantiate manpower 
needs and our budget requirements. 

So far, only a small segment of medical activities has 
been analyzed. Orthopedics is one specialty whose 
study has been completed. It clearly demonstrated a 
requirement for more orthopedic surgeons than are 
presently authorized. We have, I believe, all known this 
to be true, but in the past we have not been able to 
quantify our needs to satisfy the statisticians. 

The SHORSTAMPS methodology has been advanta- 
geous to other branches of the Navy and also to the Air 
Force. We believe it will help us also. 

Finally, you need to know that we have factor-coded a 
number of our billets. Functional area coding was 
always a mystery to me, and I suspect also to you. 
Actually, these codes are used to identify billets that 
require special consideration or are not within stated 
policy. 

In essence, functional area coding will help us alle- 
viate our billet requirements. For example, 178 Medical 
Corps billets have been temporarily released to 
increase our numbers of nurse and Medical Service 
Corps specialists, such as dietitians, clinical psycholo- 
gists, and nurse anesthetists. 



18 



U.S. Navy Medicine 



We have FAC-coded 104 billets which support the 
operational units of the Marine Corps. These people are 
medical specialists who will remain at their assigned 
hospitals but will be required to have initial field 
medical training and yearly short periods of field up- 
dating. It is a viable solution to 100% manning of es- 
sential operational requirements. Our specialists will 
be able to work in their field of expertise, but will also 
be properly oriented to a role in contingency planning. 



Medical Corps Manpower 

CAPTJ.E. Carr, MC, USN 
Director, Medical Corps Division 
BUMED Code 31 



It has become a tradition in the Medical Corps Divi- 
sion that this SAC meeting marks the commencement 
of our detailing year. It's appropriate that we take this 
time to evaluate what we have accomplished, where we 
are today, and what our goals will be for the future. 

As VADM Arentzen and RADM Milnes have men- 
tioned, we are in a much better position now than we 
had anticipated at SAC IX, as the tables that accom- 
pany this presentation will confirm. 

Table 1 is a historical comparison of our authorized 
billets and our onboard strength. It demonstrates that 
since 1969 our billets have decreased from 4,404 to the 
present level of 3,636. Our onboard strength has con- 
tinued to fall, and we will be approximately 167 physi- 
cians below authorized billets on 1 Oct 1978. Last year, 
at SAC IX, we predicted that we would have a deficit 
between 250 and 450 physicians this year. We reached 
a shortage of 242 physicians in May 1978, and then our 
position improved. This was caused in part by an in- 
crease in extension on active duty requests and a level- 
ing off in retirements and resignations. 

Table 2 is a graphic demonstration of the authorized 
billets and onboard strengths as demonstrated in Table 
1. It shows that our Medical Corps inventory has now 
reached a plateau, as predicted, and it is projected that 
we will continue to improve until we reach our Medical 
Corps requirements. My prediction now, at SAC X, is 
that our shortage of physicians should not be much 
worse in October 1979 than it is today, and hopefully 
will be somewhat better. As we enter the 1980s, we 
should be able to reach end-strength. 

A comparison of the physician shortages in the three 
uniformed services in shown in Table 3. The Army is 
experiencing a deficit of approximately 1,500 medical 
officers, and the Air Force has a shortage double that of 
the Navy. 



The Medical Corps grade distribution is presented in 
Table 4. The line Navy perceives that we are top-heavy 
in the grades of captain and commander, and it was this 
perception that influenced our promotion policies in 
recent years. Fortunately, Navy line leaders are under- 
standing our position, and we are now seeing a reversal 
of our present restrictive promotion policies and, hope- 
fully, a full return to a liberal promotion policy. 

Table 5 shows the number and grade distribution of 
female medical officers on active duty. We now have 
193 female physicians, representing about 5% of our 
strength. This level should steadily increase over the 
next decade, and this is causing a reexamination, in 
depth, of all the roles held by women in the military. 
We expect to assign our first female physicians to at 
least five ships, starting in July 1979. 

We've been telling you for several years now that the 
Berry Plan is coming to an end. Table 6 shows that we 
accessed some 32 Berry Plan physicians this summer 
and will be looking for the last 9 during July 1979. The 
loss of this pool of specialists — which accessed some 
750 physicians each year, and which provided us with 
approximately 1,500 on duty at any one time— will be 
sorely missed. 

Table 7 is a display of the specialty shortages, com- 
paring physician requirements with actual inventory. 
This is what you and your commanding officers tell 
BUMED that you need to carry out your mission. From 
this it is evident that we have a relative shortage in 
almost all specialties. But there is a problem with this. 



TABLE 1: Medical Corps Worldwide 



End Fiscal Year 


Authorized Billets* 


Onboard** 


1969 


4404 


4482 


1970 


4231 


4529 


1971 


3955 


4253 


1972 


3858 


4450 


1973 


4173 


3954 


1974 


4143 


3403 


1975 


3757 


3391 


1976 


3656 


3439 


TQ 


3696 


3628 


1977 


3651 


3524 


1978 


3636 


3467 


1979 


3675 




1980 


3611 




1981 


3641 




1982 


3643 





'Source: OPNAV 104 
"Source: BUMED Code 31. Reflects end-strengths. 



Volume 69, November 1978 



19 



TABLE 2: Actual and Projected Medical Corps End-Strengths 



5000 



4000 



3000 



ACTUAL 



A 



1972 



1976 



1977 



PROJECTED 




USN PEACETIME MEDICAL CORPS REQUIREiCUi: 



UIREHEUi:- 

(BILLET:..* 



„-..>..- " 

3467 USN MEDICAL CORPS INVENTORY (bodies) 



1978 



1979 



1980 



1981 



vm 



TABLE 3: Physician Shortage, 1 0ct 1978 



TABLE 4: Medical Corps Grade Distribution" 



Army 


25.0% 
10.% 
4.6% 


RANK 


2100 


2105 


TOTAL 


Air Force 
Navy 


VADM 
RADM 


1 

12 
362 


1 
24 


1 
13 






CAPT 


386 






CDR 


371 


72 


443 






LCDR 


283 


991 


1274 






LT 


64 


1286 


1350 






TOTAL 


1093 


2374 


3467 



'Data as of 1 Oct 1978 
Source: BUMED Code 31 



20 



U.S. Navy Medicine 



TABLE 5: Medical Corps Grade 
Distribution— Females 



TABLE 6: Berry Ran Accessions 



RANK 


2100 


2105 


TOTAL 


CAPT 


2 


___ 


2 


COR 


6 


2 


8 


LCDR 


9 


75 


84 


LT 


1 


98 


99 




^^^— 


1 III! 


___^_ 


TOTAL 


18 


175 


193 



YEAR 



ACCESSIONS 



July70{FY-71) 

July75(FY-76) 

July76(FY-7T) 

Oct76(FY-77) 

Oct77(FY-78) 

Oct 78 (FY-79) 

Oct 79 <Fr%80) 



740 
418 
211 
136 
32 



TABLE 7: Specialty Shortages (Requirement/Physicians) 1 Oct 1978 



Specialty 


Requirement 


Inventory 


+ /- 


Percent 


Flight Surgeon 


300 


193 


- 107 


36 


Internist 


292 


267 


- 25 


9 


Pediatrician 


207 


205 


- 2 


1 


Family Practice 


150 


140 


- 10 


7 


Dermatology 


47 


44 


- 3 


6 


Psychiatry 


143 


99 


- 44 


31 


Anesthesiology 


101 


95 


- 6 


6 


Neurology 


33 


25 


- 8 


24 


Physical Medicine 


4 


4 








Radio Diag 


121 


69 


- 52 


43 


Radio Therap 


10 


5 


- 5 


50 


Nuclear Medicine 


14 


8 


- 6 


43 


Pathology (Clinic) 


89 


88 


- 1 


1 


Preventive Med (Gen) 


12 


4 


- 8 


67 


Preventive Med (Aero) 


42 


X 


- 12 


29 


Preventive Med (Occup) 


16 


12 


- 4 


25 


General Surgery 


152 


125 


- 27 


18 


Neurosurgery 


17 


16 


- 1 


6 


OB-GYN 


143 


114 


- 29 


20 


Ophthalmology 


56 


49 


- 7 


13 


Orthopedic Surgery 


124 


86 


- 38 


31 


Otolaryngology 


61 


52 


- 9 


15 


Plastic Surgery 


19 


19 


_ 





Thor&CDV Surgery 


39 


36 


- 3 


8 


Urologist 


43 


40 


- 3 


7 



Volume 69, November 1978 



21 



TABI 














_E 8: Selected Medical Officer Inventories, 1 Oct 1978 


















Specialty 




Specialty 


RESTRA 


BC 


FT Inventory* 


Requirements** 




Anesthesiology 


43 


22 


75 97 




88 




Dermatology 


22 


29 


17 46 




41 




Emergency Medicine 


2 


— 


2 2 




1 




Family Practice 


73 


50 


103 153 




117 




Internal Medicine 


110 


76 


213 289 




227 




Neurology 


11 


5 


16 21 




25*** 




Nuclear Medicine 


4 


2 


3 5 




j** 




OB-GYN 


59 


35 


95 130 




114 




Ophthalmology 


27 


23 


36 59 




51 




Otolaryngology 


30 


24 


31 55 




56** 




Pathology 


43 


50 


31 81 




69 




Pediatrics 


45 


79 


129 208 




165 




Preventive Medicine 


5 


19 


9 28 




27 




Psychiatry 


30 


24 


79 103 




100 




Radiology 


47 


57 


24 81 




94*** 




Surgery— General 


52 


46 


86 132 




124 




Surgery — Neuro 


11 


5 


15 20 




11 




Surgery — Orthopedics 


46 


23 


70 93 




80 




Surgery— Plastic 


3 


4 


10 14 




7 




Surgery— Thoracic/CDV 


4 


10 


18 28 




13 




Urology 


25 


14 


26 40 




36 




* Inventory does not reflect specialties assigned to executive medicine (99) or medical research (47), and 


total does not include medical officers 


in residency training. 






** Requirements defined by authorized specialty billets. 










'"Shortages defined by billet authorizations. 










TABLE 9: Desired Primary Care Specialists 


TABLE 10: Primary Care Specialists 










Actual Inventor 


y 


Family Practice 


280 










FY-77 


FY-78 Difference 


Internal Medicine 
OB-GYN 

Pediatrics 


220 
160 
190 












Family Practice 
Internal Medicine 


94 

185 


128 +34 
156 - 29 




Clinical specialty subtotal 


850 


OB-GYN 


141 


124 - 17 








Pediatrics 


191 


211 +20 


Aerospace Medicine 
Submarine Medicine 


300 
78 




Clinical specialty subtotals 


611 


619 + 8 


Military specialty subtotal 


378 


Aerospace Medicine 


220 


184 - 36 








Submarine Medicine 


48 


40 - 8 


Nonspecialists 




504 










Total 


1,732 


Military medicine subtotals 
PCMOs 


268 

411 


224 — 44 










475 + 64 








Subtotals 


679 


699 + 20 








Totals 


1290 


1318 + 28 




22 










U.S. Navy Medicin 





TABLE 11: Physician Recruitment' 





Goal 




Appointed 




Total 
Applicants 


Appointment/ 
Applicant Ratio 


Year 


LT-LCDP 


CDR-CAPT 


Total 


FY-75 


394 


128 


31 


159 


456 


2.87 


FY-76 


187 


157 


30 


187 


512 


2.74 


FY-TQ 


240 


106 





106 


392 


3.69 


FY-77 


493 


175 


1 


176 


618 


3.51 


FY-78 


495 


152 


7 


159 


476 


3.00 


*As of 6 Sept 1978 










i 



TABLE 12: Specialties of Physicians Recruited 
FY-77 



TABLE 13: Specialties of Physicians Recruited 
FY-78* 



U.S. 
Graduates 



Foreign Medical 
Graduates 



General Surgery 


5 


Psychiatry 


4 


Neurosurgery 


3 


GMO 


17 


Pediatrics 


8 


Aviation Medicine 


12 


Dermatology 


2 


Anesthesia 


4 


Internal Medicine 


7 


Submarine Medicine 


1 


Pathology 


3 


OB-GYN 


3 


Family Practice 


4 


Orthopedics 


1 


Ophthalmology 


2 


Radiology 


1 


Urology 





Totals 


77 



5 

7 


33 
13 

3 



4 
10 



6 
10 

1 

1 



5 

1 

99 = 176 



General Surgery 

Psychiatry 

Neurosurgery 

GMO 

Pediatrics 

Aviation Medicine 

Dermatology 

Anesthesia 

Physical Medicine 

Internal Medicine 

Submarine Medicine 

Pathology 

OB-GYN 

Hematology 

Family Practice 

Orthopedics 

Radiology 

Ophthalmology 

Urology 

Totals 
*As of 6 Sept 1978 



U.S. 
Graduates 



7 

8 
2 

14 

11 

13 



2 

1 

12 
1 
2 
3 
1 
3 
2 
2 
1 
1 

86 



Foreign Medical 
Graduates 



3 

8 

2 
18 
11 

2 



3 



8 



5 

5 



3 



3 

1 

1 

73 = 159 



Table 8 compares our physician inventory, not with 
need or requirement, but with authorized billets. In this 
display, our shortage is not so apparent, and it would 
appear that we have a deficit in only several specialties. 
This is our daily problem: to document what our re- 
quirement actually is. Stated simply, we do not have 
enough billets to take care of our entire beneficiary 
population. 



Table 9 is a presentation of our desired primary care 
requirements. We would like to attain a goal of 47% of 
the Medical Corps in those primary care specialties. 
Family practice should double over the next 5-10 years. 

Table 10 is a display of our actual inventory of pri- 
mary care specialists. They are now at 38% of the 
Medical Corps, an increase from 35.6% last year. 

Physician recruitment over the last four years is dis- 



Volume 69, November 1978 



23 



TABLE 14: Armed Forces Health Professions Scholarship Program 



Fiscal Year 


Number of 


Navy 


Navy 


Civilian 


NADDS 


Degree Received 


Graduates 


Interns 


Residents 


Interns 


Deferment 


1975 


300 


92 


45 


30 


133 


1976 


356 


80 


52 


214 


10 


1977 


250 


172 





49 


29 


1978 


295 


185 





63 


47 


1979 


400 


200/250 





100/150 


0/50 


1980 


400 


200/250 





100/150 


0/50 


1981 


400 


200/250 





100/150 


0/50 



TABLE 15: PCMOs (GMOs) Needed for 
Operational Billets (Summer 1979) 



TABLE 16: PCMO Assets to Fill Operational 
Billets (Summer 1979) 



Fleet, Atlantic 


52 


Navy interns 


(July 79) 


220 


(23 female) 


Fleet, Pacific 


52 




(Jan-Mar 79) 


16 




Marines, Seabees, Regions 


106 




(Sept 79) 


2 




Flight Surgeons 


50 






238 




Sub Med 


20 












280 


Civilian Interns 


(July 79) 
(Jan 79) 


60 

5 

65 


(3 female) 












Total 






303 













played in Table 11. Recruiting for FY-78 will be about 
the same as for FY-77, and we now are able to access 
some commanders in certain critical specialties. 

Table 12 is a final report for recruiting last year (FY- 
77) and shows that foreign medical graduates exceeded 
U.S. -trained graduates during that year. This trend has 
now been reversed, as you will note in Table 13. 

The Armed Forces Health Professions Scholarship 
Program is displayed in Table 14. We were able to 
select some 557 students from more than 1,000 appli- 
cants, and our program is fully subscribed. This will in- 
crease the number of graduates available to us. We 
have increased the number of Navy internships and 
hope to increase civilian deferments in the future. This 
expanding pool of scholarship students— which, to- 
gether with graduates of the Uniformed Services 
University of the Health Sciences, will provide us with 
approximately 1,500 physicians on active duty at any 
one time— is our hope for the future. We will need to 
train them in order to provide our specialists of the 
future. 



For four years now, we have promised the line Navy 
that we would support the fleet with 100% physician 
manning. We have done a pretty good job, and we 
intend to carry out that promise again next summer. 
Table 15 shows that we will need 280 primary care med- 
ical officers to replace those vacating operational billets 
next summer. Table 16 shows where our assets are to 
come from to fill those operational billets, and you can 
see that the margin is very narrow. 

Please forgive me if I appear to be overly optimistic. 
But we have been through, and are going through, a 
very difficult time, and yet the signs are improving. The 
quantity and quality of scholarship students is marked- 
ly increased. Extensions are ahead of last year's num- 
bers. Recruiting is holding its own, and the quality of 
recruits is decidedly better. 

Again it has been confirmed that we cannot depend 
upon recruitment to supply us with trained specialists. 
We must continue to try to train at full capacity, while 
supporting the operational Navy to the best of our 
ability. 



24 



U.S. Navy Medicine 



Budget Update: Dollars, 
Facilities, Equipment 

RADM A.C. Wilson, MC, USN 
Assistant Chief for Materiel Resources 
BUMED Code 4 



This morning I want to address the current status and 
outlook on the Medical Department's money, places, 
and things. Since money is critical to virtually every- 
thing, I will start with the status of funding, then de- 
scribe for you the facilities and equipment milieu. 

In retrospect, we have not fared too badly in FY-78, 
although we've had some anxious moments at various 
times, wondering whether or not this or that piece of 
the budget would be approved or withheld. 

The Navy Medical Department is a microcosm of the 
government as a whole, in the sense that it responds to 
the various pressures brought on by changes in this 
country and the world in general. The circumstances 
which are now influencing our budgetary matters are 
several— for example, the Presidential pledge of a 
balanced budget, which means either higher taxes or 
lower government costs. Proposition 13 in California 
has had an enormous impact and has been the driving 
force in reduction of government spending. 

In the Medical Department we have experienced a 
consistent decline in workload, due in part to reduction 
of the end-strength of the Navy and Marine Corps and 
in part to reduction in the average length of patient stay 
in the hospital. Yet, when the length of patient stay is 
reduced, the cost per patient day rises, because the cost 
of keeping the door open either remains stable or rises. 
In 1976, there was a $10 million reduction in BU- 
MED's budget base. Since the budget is constructed on 
an incremental basis— i.e., next year's budget is 
usually this year's budget plus some new programs 
plus inflation— the base on which the next budget is 
calculated is critical. To date we have been unable to 
get the budget base restored to the figure that it would 
have been prior to 1976, using a 1975 base. That's been 
a problem. 

As a part of the Navy, we have received our fair share 
of general forms of reduction. Over the past few years, 
these have included dollar reductions; staffing reduc- 
tions, both in uniformed personnel and civil servants; 
constraints on travel funds; reduction in dollars to deal 
with inflation; and limitations on the growth of some 
desirable programs, such as OSHA. 

As you are well aware, the history of low funding has 
created some retention problems. We are, by law and 
custom, expected to deliver health care on request. Any 
reduction in care, whether real or imaginary, is per- 

Volume 69, November 1978 



FIGURE 1 : Major Budget Changes for FY 1979 
(as Requested in FY 1979 President's Budget) 



<$000) 



General Support Staffing (270 civilians) 
Occupational Health (80 technicians) 
Safety (14 safety officers) 
Hearing Conservation (16 technicians) 
Maintenance and Repair —Real Property 
Minor Construction /Alteration 
Laboratory Technicians (38 civilians) 
Inflation 

Total — Major increases 



+ 


1,646 


+ 


2,000 


+ 


119 


+ 


144 


+ 


6,202 


+ 


1,048 


+ 


276 


+ 


12,248 


+ 


23,683 



FIGURE 2: FY 1980 Budget (Currently Undergoing 
Navy/OSD/OMB Review) 





($000) 


Major Changes: 
Occupational Health (Contracts) 
Maintenance and Repair— Real Property 
Closure of Inpatient Functions at 

Several Hospitals 
Inflation 

Net Change 


+ 2,645 
+ 7,000 

- 2,451 
+ 12,894 

+ 20,088 



ceived as a condition which is reversible if one com- 
plains loudly enough. 

There is another issue impacting on us, and that is 
doing as much as possible by contract. 

If we contract for a service, it obviously means that 
we do not require a Civil Service employee or a uni- 
formed individual to do the job. This impacts on the 
Civil Service end-strength of the Medical Department, 
and can impact on our uniformed strength as well. 

Certain functions in selected activities lend them- 
selves to contracting out— for example, housekeeping 
and food services. But those skills which we are re- 
quired to take with us when we go to war— the skills of 
men and women in uniform— must continue to be exer- 
cised. Our efforts are devoted to determining where 
and what we should contract out, and what skills we 
must protect as the necessary ones for contingencies. 

The bottom line for all these issues is that we are 
being asked to do more with less. We try to cut corners 
to save dollars, but there are pressures beyond our 
control which do not permit our independence in these 



25 




RADM Wilson 



CAPT Carr 



matters. As a result, we find ourselves in a "reaction" 
posture rather than in an "action" posture. We are 
sometimes asked to refight battles we thought we'd 
already won. 

Figure 1 shows the major budget changes in FY-79. 
There's a strong emphasis on occupational health, 
maintenance, minor construction, and addressing the 
inflation problem. 

We're getting dollars for FY-79, but as of today we 
do not have a firm control number that tells us what our 
dollar figure will be. We do know that we have had our 
inflation line item decreased by about one third, but the 
other decisions haven't been announced. The general 
feeling about FY-79 is that it may not be a vintage year, 
but it may not be all that bad, either. 

Figure 2 outlines the major changes we've asked for 
in the 1980 budget, which is currently undergoing re- 
view by Navy, OSD, and OMB. 

In the upcoming year, the Medical Department needs 
the conscious efforts of all its members to assure that 
we spend our money wisely and well and get the 
maximum benefit from it. These are some of the things 
you can do to contribute to sound financial manage- 
ment: 

• Get involved and stay involved. As program man- 
agers, you know there's nothing in this country that 
changes as rapidly as the price of things. To manage 
your money adequately, you must know not only what 
you have and what it costs to operate and maintain, but 
also what you want to replace and what it costs to buy 
the replacement. 



26 



• Being a target manager or a program manager 
does not mean only spending money. There's a require- 
ment to manage those dollars: to identify alternatives 
and options, and to spend those dollars on the best 
options. If you've had no experience or are having trou- 
ble managing your department's budget, the fiscal or 
supply officer would be happy to give you a hand and 
help you learn. 

• You must stay current, for the reasons we've just 
mentioned. The marketplace changes daily, and what 
you determined was a sound operating cost or replace- 
ment cost last week is likely to be out of date this week. 

• You must learn to forecast — to look ahead and 
identify problems before they occur— so we can plan for 
that new piece of equipment you need to stay abreast of 
the state-of-the-art of medicine. Problems and require- 
ments need to be identified early. 

• Finally, you must plan ahead. As you know, the 
Navy and the government at large operate on a 
five-year defense plan. We need similar plans for the 
Medical Department and its activities, and this includes 
your department. You need to think about and discuss 
what things are probably going to transpire in the next 
five to ten years. Will the anticipated changes in the 
state-of-the-art affect your specialty? Will those 
changes require more people, more money, more 
space, or additional equipment? If they do, how much, 
and what kind of each will be required? 

In 1974, we started a medical modernization program 
for our facilities, designed to remedy construction 
needs over a five-year period. The money for this pro- 

U.S. Navy Medicine 



gram was held under tight control by DOD, through a 
mechanism known as "fencing," for the first three 
program years. In FY-77, however, the money was un- 
fenced, and control was returned to the individual mili- 
tary services. 

We've accomplished an enormous amount of con- 
struction since 1974: 68 major projects were authorized, 
and 13 are still under way. In FY-79, we have six proj- 
ects: a new hospital at Camp Lejeune, a new regional 
dental center at Norfolk, the third phase of center re- 
development at Bethesda, replacement of the biomedi- 
cal research laboratory in Cairo, an industrial clinic at 
MCAS Cherry Point, and a medical/dental clinic for the 
basic school at Quantico. 

We still have $900 million worth of construction to 
accomplish; however, in FY-78 the Medical Depart- 
ment construction program was all but eradicated. We 
built one BEQ in FY-78. 

FY-79 looks better, with a pricetag of about $71 mil- 
lion on those projects I mentioned. 

One point should be remembered: All the work in the 
Navy Medical Department is important work or we 
wouldn't be doing it. but every program we present is 
in competition with ships, aircraft, weapons systems, 
and other Navy programs. There's a strong feeling in 
government today that we must do everything possible 
to maintain what we have, at the same time competing 

appropriately for new things. In the facilities world, this 
means more emphasis on maintenance and repair of 
existing systems and spaces, and it means that you 
must be continually aware of the maintenance needs in 
your own areas of responsibility. 

Just for a moment, I'd like to highlight some of the 
things that are now going on. 

We returned some property to the Japanese govern- 
ment, on a quid pro quo basis, and they're building a 
new hospital for us in Yokosuka that should be ready for 
us to use in about a year. 

The new hospital at Bethesda is about 18 months 
from completion, and construction is going along very 
nicely. The last phase of the total NNMC project- 
modernizing the tower and other older buildings— is 
programmed in FY-81. 

As many of you know, weve had considerable diffi- 
culty siting the San Diego replacement hospital, but 
we hope the issue of the new location will be resolved 
shortly, so we can get the new hospital built. 

We're starting a tri-service study of medical care 
needs in the Oakland Bay area, the driving force behind 
which is the fact that, as new as Letterman and Oak 
Knoll are, they've not designed to withstand earth- 
quakes. Both of them need seismic upgrading, which is 
very expensive, and that's the reason for this study: to 
determine if we need both hospitals and, if not, which 
one should close? We're well aware of the large con- 



tribution Oak Knoll makes to our total training effort. 
Suffice it to say that no decisions have been made 
ahead of time, no commitments have been made, and 
the study will be objective. 

As you know, the New Orleans hospital is finally 
closed. We don't know what's going to happen to it, but 
it's being offered for lease. 

The final issue I'd like to discuss is our equipment 
program. 

The Equipment and Logistics Division, BUMED 
Code 43, was established a year ago, with CAPT Lou 
Mantel as its director. We now have a much better 
management system for our equipment than we had 
before. We've had good support from CNO in FY-78 in 
getting equipment dollars. FY-79 doesn't look quite as 
favorable, but we're still far better off than in many 
years in the past. 

You're undoubtedly well aware that the computer 
tomography scanner has brought a new kind of surveil- 
lance to the equipment program. Virtually every 
governing body in the country, from OSD down to the 
local community health planners, is interested in con- 
trolling the number of CT scanners. We're doing rea- 
sonably well in our own program. 

We're planning new equipment-related programs 
for the upcoming year, the most important of which 
is better preventive maintenance. LT Tom Defibaugh 

has been transferred to BUMED Code 43 from Phila- 
delphia's Naval Medical Materiel Support Command, 
and he'll be setting up the maintenance program. 

We also anticipate moving the Naval Medical 
Materiel Support Command to Fort Detrick. The Army 
and Air Force have their medical materiel divisions 
there, and the move will allow us to take advantage of 
the other services' systems and programs. 

BUMED Code 42 will continue its usual function of 
caring for the fleet, but in addition will start some new 
activities, including an inventory control system for 
investment equipment and some noninvestment equip- 
ment. To sum up, we've talked about money and how 
hard it is to come by. We have to use it wisely. We've 
had pretty good luck this year, and we're hopeful about 
next year. 

We've said that the military construction program is 
constrained in funding somewhat, but we're still build- 
ing some new facilities, and we're making some pro- 
gress. 

The equipment scene is improving. We're moderniz- 
ing and enlarging the equipment acquisitions system in 
BUMED, and putting emphasis on proper selection, 
proper utilization, and proper maintenance. 

All these issues involve you as program directors, 
and it is incumbent on you to contribute your time and 
expertise when indicated, so that we can continue to 
march along in the right direction. 



Volume 69, November 1978 



27 



Scholars' Scuttlebutt 



Your Reimbursements: Speeding the Process 



If you are a student in the Armed 
Forces Health Professions Scholar- 
ship program (AFHPSP), you are 
familiar with reimbursement 
claims. They are a necessary evil, 
requiring time to fill out and time to 
process. They are completed on 
Standard Form 1164 and are sub- 
mitted once each Fiscal quarter. 

Reimbursement claims take ap- 
proximately four to six weeks to 
process and are responsible for 
about 40% of the workload at Code 
9, Health Sciences Education and 
Training Command (HSETC). This 
is the process that your reimburse- 
ment claim (along with 1,500 others 
each quarter) must undergo before 
payment can be made: 

• About a month before the end 
of each federal fiscal quarter, a 
blank SF 1164, an instruction sheet, 
a school certification, and an infor- 
mation letter are mass-mailed to all 
AFHPSP students. 

• You and other students in the 
AFHPSP complete your claims for 
the applicable fiscal quarter (termed 
"purchase period" on the instruc- 
tion sheet) and return them to Code 
9, HSETC. 

• When we receive your claim, it 
is date-stamped, then screened for 
signature, purchase dates, mixed 
purchase periods, social security 
number, and readable carbon cop- 
ies. Claims are immediately re- 
turned when there are discrepancies 
in any of these areas. 

• After your claim is screened, 
the receipts are copied and passed 
on to your processor. The processor 
reviews your past claims, checks 
your items against your receipts, 
checks the addition, separates the 



28 



amounts into categories (books, 
supplies, fees, microscope rental), 
and enters the categorized amounts 
on your personal record and in a 
master financial book that main- 
tains a running total of all money 
expended on behalf of Navy 
AFHPSP students. The processor 
must then type accounting data and 
signature information on your 
claim. The first carbon copy and a 
copy of all your receipts are filed in 
your personal financial record while 
the original claim, with remaining 
copies and receipts, is forwarded to 
the HSETC comptroller for further 
review and signature. 

• The HSETC comptroller's of- 
fice screens your claim for account- 
ing-data accuracy and sends one 
carbon copy to the fiscal office at the 
National Naval Medical Center for 
keypunching. This is the copy that 
charges the amount of your claim 
against HSETC funds. The original 
claim and the remaining copies are 
then forwarded to the Navy Re- 
gional Finance Center (NRFC) in 
Washington, D.C. 

• NRFC processors review the 
claim, check your receipts, check 
the addition, and finally forward 
your claim to their fiscal office for 
payment. The fiscal office makes 
out your check and forwards it to 
you, using one of your claim copies 
in a window envelope. The original 
claim and remaining carbon copies 
are used for other purposes within 
NRFC. 

As you can see, your claim passes 
through many hands. There can be 
a bottleneck at any point along its 
journey when processors take leave, 
report sick, spend too much time on 



"problem" claims, or attend to 
other more pressing matters that 
divert them from their processing 
duties. 

Your help counts. You can help 
speed the flow by submitting neat, 
legible claims and closely following 
the instructions that accompany 
each claim form. Unfortunately, 
many students do not read the in- 
structions and are perturbed when 
their claims are returned for seem- 
ingly minor discrepancies. For a 
time, these minor discrepancies 
were simply corrected by the proc- 
essors. As time passed, however, 
more and more students were dis- 
regarding the instructions, to the 
point where almost every claim 
needed some type of correction or 
adjustment. It became apparent 
that the only way to ensure that 
claims were properly completed was 
to return them to the student when- 
ever there was a discrepancy. 

One of the most frustrating prob- 
lems encountered by NRFC is 
carbon copies that cannot be read. 
Every copy is used, and all must be 
legible. 

We do not like to return your 
claim because of minor errors, but it 
is the only way to ensure proper 
submission in the future. Claims 
processing is not a simple, one- 
office procedure. Each office in the 
processing chain must abide by 
established laws and regulations. 
That is why we are so particular 
about receipts, dates, signatures, 
legibility, content, and neatness. 

We may not be able to change the 
system, but with your help we may 
be able to make it a little more re- 
sponsive. 

U.S. Navy Medicine 



BUMED SITREP 



SURVEY TO DEVELOP PHYSICIAN WORK PROFILE 

... In the latter part of this month and early in Decem- 
ber, the Naval School of Health Sciences, Bethesda, 
Md., will be conducting a survey of all shore-based 
Navy physicians. 

Past surveys, which have tended to focus on career 
satisfiers and dissatisfiers, have too often resulted in 
conclusions and recommendations that are not readily 
subject to in-house control. The current survey, how- 
ever, addresses the Navy physician's immediate job 
environment. What does the physician do? Who sup- 
ports him or her? How well is he or she supported? 
What organizational factors enhance or inhibit the phy- 
sician's work? 

With an accurate physician work profile, Medical 
Department managers can better modify organizational 
arrangements so as to match physicians' professional 
goals with the varied needs of their patients. 

Since a survey investigation, by its very nature, re- 
quires the whole-hearted cooperation of respondents to 
be successful, the Research Department of the Nava! 
School of Health Sciences earnestly solicits that coop- 
eration from Navy physicians in the days ahead. 

MED SCHOOL OPPORTUNITIES IMPROVED . . . 

ROTC and service academy graduates can now partici- 
pate in government medical education programs. The 
three military services have moved to allow ROTC 
graduates and as much as 2% of the graduating class of 
each academy (depending upon service needs) to enter 
the Armed Forces Health Professions Scholarship 
Program or attend the Uniformed Services University 
School of Medicine. 

FLIGHT SURGEON BILLETS AVAILABLE . . . Billets 
are available for flight surgeons at the Naval Aerospace 
Medical Research Laboratory, Pensacola, Fla., and the 
Naval Air Development Center (NADC), Warminster, 
Pa. 

The NADC billet is described as follows: "A new 
generation of Navy aircraft is capable of sustained 
high-G flight. At NADC, research is directed toward 
enhancing pilot performance for the demands of this 
environment. There is an immediate requirement for an 
experienced flight surgeon to become a member of a 
multidisciplinary research team employing the most 
sophisticated human centrifuge in the free world and 
other acceleration platforms. Other research activities 
encompass cold water survival and perceptual studies. 
The incumbent also supervises a Navy subject pool, re- 
views and coordinates research efforts involving the 



use of human beings, provides interagency liaison for 
programs using Navy acceleration platforms, and pro- 
vides medical care for NADC's aviation community. In- 
house research funds are available for approved inde- 
pendent research." 

Blue Angels. The Navy Flight Demonstration Team 
will require a flight surgeon in January 1979. LT Ber- 
nard Gipson, MC, USN, currently with the "Blues," 
can provide detailed information. 

Anyone interested in any of these challenging billets 
should call CDR Jim Black, MC, USN, BUMED Code 
311-1, at Autovon 294-4390. 



POSTDOCTORAL ASSOCIATESfflPS . . . Applications 
are now being accepted for the postdoctoral research 
associateship programs conducted by the National Re- 
search Council of the National Academy of Sciences on 
behalf of the Naval Medical Research and Development 
Command (NMRDC). 

Under the programs, postdoctoral biomedical engi- 
neers and medical, biological, and behavioral scientists 
participate in biomedical research projects conducted in 
NMRDC laboratories. Awards, made on a competitive 
basis, are tenable at five Navy facilities: the Naval 
Medical Research Institute, Bethesda, Md.; the Naval 
Aerospace Medical Research Laboratory, Pensacola, 
Fla.; the Aircraft and Crew Systems Technology Direc- 
torate, Naval Air Development Command, Warminster, 
Pa.; the Naval Submarine Medical Research Labora- 
tory, Groton, Conn.; and the Naval Health Research 
Center, San Diego, Calif. 

Areas in which the research associateships are 
awarded are: experimental medicine, immunology, 
undersea medicine, aerospace medicine, behavioral 
sciences, biochemistry, biophysics, environmental 
stress, microbiology, parasitology, virology, biomag- 
netics, physiology, and radiation biology. 

Candidates must hold an M.D., a D.D.S., or a Ph.D. 
degree or the equivalent, and must be research 
oriented. 

The National Research Council screens the candi- 
dates' records, selects applicants, and approves the 
scientific merits of laboratory projects and the creden- 
tials of research advisors. 

Applications must be postmarked no later than 15 
Jan 1979 and must be received in the Council's Asso- 
ciateship Office no later than 25 Jan 1979. Supporting 
documents must be received by 12 Feb 1979. 

For further details, write: Associateship Office (JH- 
608-NI), National Research Council, 2101 Constitution 
Ave., N.W., Washington, D.C. 20418. 



Volume 69, November 1978 



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